| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2499 |
Variable asphericity lens |
428 |
394 |
$34K |
| 92340 |
|
2,580 |
2,267 |
$33K |
| V2784 |
Lens polycarb or equal |
2,535 |
2,232 |
$33K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,309 |
1,173 |
$15K |
| V2020 |
Vision svcs frames purchases |
2,567 |
2,257 |
$11K |
| V2100 |
Lens spher single plano 4.00 |
624 |
565 |
$8K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
54 |
43 |
$780.00 |
| V2101 |
Single visn sphere 4.12-7.00 |
67 |
58 |
$636.40 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
16 |
13 |
$189.20 |
| V2106 |
Spherocylinder 4.00d/>6.00d |
13 |
12 |
$172.00 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
12 |
12 |
$172.00 |