| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,424 |
5,103 |
$96K |
| V2025 |
Eyeglasses delux frames |
3,050 |
2,984 |
$85K |
| V2020 |
Vision svcs frames purchases |
5,605 |
5,193 |
$82K |
| V2784 |
Lens polycarb or equal |
5,345 |
5,146 |
$54K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,880 |
1,743 |
$30K |
| V2100 |
Lens spher single plano 4.00 |
1,389 |
1,310 |
$22K |
| V2750 |
Anti-reflective coating |
2,328 |
2,268 |
$14K |
| V2107 |
Spherocylinder 4.25d/12-2d |
575 |
531 |
$9K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
155 |
147 |
$4K |
| V2799 |
Misc vision item or service |
24 |
24 |
$93.03 |
| V2744 |
Tint photochromatic lens/es |
14 |
13 |
$50.89 |