| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Eyeglasses delux frames |
9,144 |
6,343 |
$547K |
| 92004 |
|
4,649 |
3,879 |
$335K |
| V2100 |
Lens spher single plano 4.00 |
9,204 |
7,217 |
$296K |
| V2784 |
Lens polycarb or equal |
3,028 |
2,232 |
$182K |
| 92014 |
|
2,615 |
2,382 |
$175K |
| 99211 |
|
11,666 |
8,584 |
$141K |
| 92015 |
|
4,122 |
3,915 |
$113K |
| S0580 |
Polycarb lens |
2,355 |
1,276 |
$94K |
| V2020 |
Vision svcs frames purchases |
5,449 |
4,158 |
$79K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,103 |
1,807 |
$38K |
| V2760 |
Scratch resistant coating |
2,172 |
1,278 |
$24K |
| V2715 |
Prism lens/es |
1,164 |
949 |
$9K |
| V2410 |
Lens variab asphericity sing |
95 |
69 |
$6K |
| V2744 |
Tint photochromatic lens/es |
422 |
371 |
$5K |
| V2799 |
Misc vision item or service |
322 |
290 |
$5K |
| V2730 |
Special base curve |
194 |
159 |
$3K |
| V2520 |
Contact lens hydrophilic |
35 |
25 |
$2K |
| V2200 |
Lens spher bifoc plano 4.00d |
13 |
13 |
$1K |
| 92012 |
|
13 |
12 |
$625.96 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
49 |
14 |
$511.45 |
| 92340 |
|
18 |
17 |
$251.94 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
15 |
12 |
$140.64 |
| V2755 |
Uv lens/es |
746 |
438 |
$5.00 |
| V2756 |
Eye glass case |
19 |
16 |
$0.00 |