| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
8,833 |
7,259 |
$124K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,621 |
3,812 |
$70K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
782 |
605 |
$27K |
| V2100 |
Lens spher single plano 4.00 |
1,799 |
1,478 |
$25K |
| V2784 |
Lens polycarb or equal |
1,038 |
841 |
$14K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
351 |
258 |
$4K |
| V2107 |
Spherocylinder 4.25d/12-2d |
175 |
142 |
$3K |
| V2781 |
Progressive lens per lens |
87 |
67 |
$3K |
| V2200 |
Lens spher bifoc plano 4.00d |
28 |
25 |
$947.51 |
| V2025 |
Eyeglasses delux frames |
21 |
13 |
$489.60 |