| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,727 |
6,007 |
$192K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,977 |
3,480 |
$76K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,080 |
1,858 |
$39K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,051 |
1,010 |
$12K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
158 |
156 |
$7K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
50 |
47 |
$5K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
30 |
30 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
42 |
38 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
70 |
59 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
46 |
41 |
$748.70 |
| V2025 |
Deluxe frame |
260 |
260 |
$686.00 |
| V2750 |
Anti-reflective coating, per lens |
753 |
678 |
$330.00 |
| V2744 |
Tint, photochromatic, per lens |
18 |
15 |
$64.60 |
| V2799 |
Vision item or service, miscellaneous |
15 |
12 |
$0.00 |