| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Lens spher single plano 4.00 |
1,920 |
1,297 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
12,497 |
6,898 |
$0.00 |
| 92002 |
|
4,163 |
4,139 |
$0.00 |
| S0500 |
Dispos cont lens |
1,678 |
1,659 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
2,061 |
1,018 |
$0.00 |
| 92004 |
|
625 |
623 |
$0.00 |
| 92250 |
|
1,687 |
1,662 |
$0.00 |
| V2799 |
Misc vision item or service |
597 |
299 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,271 |
838 |
$0.00 |
| S0581 |
Nonstnd lens |
640 |
319 |
$0.00 |
| 92310 |
|
1,491 |
1,457 |
$0.00 |
| V2781 |
Progressive lens per lens |
56 |
28 |
$0.00 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
20 |
12 |
$0.00 |
| 92014 |
|
7,815 |
7,726 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
2,155 |
1,178 |
$0.00 |
| V2020 |
Vision svcs frames purchases |
10,987 |
10,871 |
$0.00 |
| V2750 |
Anti-reflective coating |
5,949 |
2,979 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
614 |
375 |
$0.00 |