| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
5,375 |
5,144 |
$146K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,000 |
2,881 |
$59K |
| V2100 |
Lens spher single plano 4.00 |
2,078 |
2,002 |
$42K |
| V2784 |
Lens polycarb or equal |
2,192 |
2,162 |
$32K |
| V2025 |
Eyeglasses delux frames |
1,060 |
1,059 |
$10K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
136 |
136 |
$5K |
| V2750 |
Anti-reflective coating |
883 |
869 |
$4K |
| V2200 |
Lens spher bifoc plano 4.00d |
65 |
65 |
$3K |
| V2781 |
Progressive lens per lens |
50 |
50 |
$2K |
| V2521 |
Cntct lens hydrophilic toric |
13 |
13 |
$1K |
| V2107 |
Spherocylinder 4.25d/12-2d |
38 |
38 |
$777.80 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
18 |
13 |
$330.00 |
| V2744 |
Tint photochromatic lens/es |
14 |
14 |
$0.00 |