| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
35,818 |
34,463 |
$734K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
24,274 |
23,490 |
$530K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
9,257 |
8,969 |
$179K |
| V2100 |
Lens spher single plano 4.00 |
6,306 |
6,128 |
$136K |
| V2025 |
Eyeglasses delux frames |
3,199 |
3,140 |
$84K |
| V2107 |
Spherocylinder 4.25d/12-2d |
1,654 |
1,599 |
$32K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
1,402 |
1,369 |
$27K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
1,010 |
980 |
$19K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
89 |
88 |
$2K |
| V2101 |
Single visn sphere 4.12-7.00 |
15 |
13 |
$211.88 |