| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,950 |
3,630 |
$167K |
| 92014 |
|
4,631 |
4,307 |
$155K |
| 92004 |
|
2,404 |
2,218 |
$138K |
| V2020 |
Vision svcs frames purchases |
4,976 |
4,563 |
$42K |
| 92015 |
|
6,720 |
6,221 |
$40K |
| 92340 |
|
5,766 |
5,312 |
$37K |
| V2100 |
Lens spher single plano 4.00 |
1,150 |
1,047 |
$35K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
770 |
715 |
$27K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
606 |
545 |
$27K |
| V2599 |
Contact lens/es other type |
168 |
151 |
$21K |
| V2107 |
Spherocylinder 4.25d/12-2d |
195 |
183 |
$7K |
| 92341 |
|
710 |
639 |
$3K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
12 |
12 |
$367.50 |
| 92310 |
|
163 |
151 |
$100.00 |
| V2744 |
Tint photochromatic lens/es |
18 |
15 |
$0.00 |
| V2750 |
Anti-reflective coating |
289 |
277 |
$0.00 |
| V2784 |
Lens polycarb or equal |
545 |
517 |
$-65.00 |
| V2025 |
Eyeglasses delux frames |
2,038 |
1,871 |
$-246.00 |