| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
4,051 |
3,923 |
$66K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,702 |
2,655 |
$47K |
| V2100 |
Lens spher single plano 4.00 |
1,563 |
1,478 |
$27K |
| V2784 |
Lens polycarb or equal |
2,709 |
2,604 |
$21K |
| V2025 |
Eyeglasses delux frames |
1,229 |
1,180 |
$21K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
581 |
573 |
$9K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
55 |
55 |
$1K |
| V2599 |
Contact lens/es other type |
14 |
14 |
$1K |
| V2520 |
Contact lens hydrophilic |
13 |
13 |
$917.59 |
| V2107 |
Spherocylinder 4.25d/12-2d |
25 |
25 |
$435.00 |
| V2781 |
Progressive lens per lens |
13 |
12 |
$45.00 |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
225 |
217 |
$0.00 |
| V2799 |
Misc vision item or service |
220 |
196 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
27 |
26 |
$0.00 |
| V2745 |
Tint, any color/solid/grad |
594 |
581 |
$0.00 |
| V2750 |
Anti-reflective coating |
1,976 |
1,868 |
$0.00 |