| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Lens spher single plano 4.00 |
31,732 |
10,117 |
$864K |
| V2020 |
Vision svcs frames purchases |
18,391 |
12,220 |
$723K |
| 92014 |
|
8,302 |
8,169 |
$360K |
| 92004 |
|
6,306 |
6,198 |
$276K |
| V2750 |
Anti-reflective coating |
3,245 |
1,327 |
$65K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,424 |
687 |
$54K |
| V2744 |
Tint photochromatic lens/es |
1,375 |
601 |
$45K |
| V2784 |
Lens polycarb or equal |
26,360 |
7,707 |
$35K |
| V2760 |
Scratch resistant coating |
2,891 |
990 |
$27K |
| V2299 |
Lens bifocal speciality |
696 |
345 |
$26K |
| V2781 |
Progressive lens per lens |
704 |
349 |
$25K |
| V2520 |
Contact lens hydrophilic |
112 |
108 |
$9K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
196 |
88 |
$6K |
| 92015 |
|
7,538 |
7,402 |
$4K |
| 92340 |
|
365 |
349 |
$4K |
| V2745 |
Tint, any color/solid/grad |
214 |
106 |
$1K |
| 92310 |
|
14 |
14 |
$741.36 |