| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
6,073 |
5,267 |
$168K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,536 |
2,996 |
$63K |
| V2100 |
Lens spher single plano 4.00 |
1,392 |
1,163 |
$23K |
| V2784 |
Lens polycarb or equal |
1,060 |
1,039 |
$17K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
206 |
201 |
$8K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
84 |
84 |
$6K |
| V2410 |
Lens variab asphericity sing |
82 |
82 |
$5K |
| V2750 |
Anti-reflective coating |
756 |
714 |
$4K |
| V2520 |
Contact lens hydrophilic |
25 |
25 |
$2K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
98 |
83 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
74 |
62 |
$1K |
| V2200 |
Lens spher bifoc plano 4.00d |
12 |
12 |
$372.00 |
| V2744 |
Tint photochromatic lens/es |
29 |
28 |
$32.30 |
| V2025 |
Eyeglasses delux frames |
12 |
12 |
$10.00 |
| V2799 |
Misc vision item or service |
147 |
139 |
$0.00 |