| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
225,492 |
219,610 |
$1.83M |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
119,595 |
116,435 |
$870K |
| V2100 |
Lens spher single plano 4.00 |
51,085 |
49,669 |
$334K |
| V2781 |
Progressive lens per lens |
8,572 |
8,414 |
$315K |
| V2784 |
Lens polycarb or equal |
118,612 |
114,838 |
$250K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
29,388 |
28,945 |
$246K |
| V2760 |
Scratch resistant coating |
118,345 |
114,588 |
$246K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
3,862 |
3,810 |
$181K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
21,111 |
20,480 |
$127K |
| V2107 |
Spherocylinder 4.25d/12-2d |
14,855 |
14,435 |
$94K |
| V2200 |
Lens spher bifoc plano 4.00d |
11,361 |
11,178 |
$81K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
1,736 |
1,538 |
$74K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
4,693 |
4,543 |
$26K |
| V2750 |
Anti-reflective coating |
1,544 |
1,474 |
$23K |
| V2101 |
Single visn sphere 4.12-7.00 |
3,598 |
3,501 |
$21K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
3,586 |
3,459 |
$20K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
2,501 |
2,422 |
$16K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
2,338 |
2,302 |
$15K |
| V2025 |
Eyeglasses delux frames |
1,175 |
1,132 |
$14K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
1,701 |
1,668 |
$12K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
1,149 |
1,108 |
$7K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
1,092 |
1,058 |
$6K |
| 92340 |
|
353 |
338 |
$5K |
| V2799 |
Misc vision item or service |
1,185 |
1,169 |
$3K |
| V2102 |
Singl visn sphere 7.12-20.00 |
179 |
175 |
$1K |
| V2208 |
Lens sphcy bifocal 4.25-7/2. |
168 |
163 |
$1K |
| V2211 |
Lens sphcy bifo 7.25-12/.25- |
92 |
88 |
$599.00 |
| V2201 |
Lens sphere bifocal 4.12-7.0 |
65 |
63 |
$389.00 |
| V2205 |
Lens sphcy bifocal 4.00d/4.2 |
30 |
29 |
$165.00 |
| V2113 |
Spherocylindr 7.25d/4.25-6d |
14 |
14 |
$77.00 |