| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
547 |
542 |
$0.00 |
| S0500 |
Dispos cont lens |
923 |
921 |
$0.00 |
| 92250 |
|
2,616 |
2,552 |
$0.00 |
| 92002 |
|
4,521 |
4,501 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
10,786 |
6,188 |
$0.00 |
| V2100 |
Lens spher single plano 4.00 |
1,737 |
1,248 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
243 |
165 |
$0.00 |
| 92310 |
|
920 |
889 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
596 |
309 |
$0.00 |
| S0581 |
Nonstnd lens |
101 |
51 |
$0.00 |
| V2799 |
Misc vision item or service |
24 |
12 |
$0.00 |
| V2781 |
Progressive lens per lens |
30 |
15 |
$0.00 |
| 92014 |
|
5,693 |
5,571 |
$0.00 |
| V2020 |
Vision svcs frames purchases |
9,638 |
9,542 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
790 |
454 |
$0.00 |
| V2750 |
Anti-reflective coating |
2,555 |
1,289 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
162 |
103 |
$0.00 |