| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
7,542 |
3,319 |
$250K |
| 92014 |
|
3,472 |
3,429 |
$139K |
| V2020 |
Frames, purchases |
5,555 |
4,359 |
$108K |
| 92004 |
|
1,864 |
1,840 |
$75K |
| V2750 |
Anti-reflective coating, per lens |
2,181 |
1,187 |
$30K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,727 |
2,908 |
$29K |
| V2744 |
Tint, photochromatic, per lens |
893 |
471 |
$24K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
106 |
65 |
$5K |
| 92012 |
|
126 |
126 |
$5K |
| V2781 |
Progressive lens, per lens |
78 |
43 |
$5K |
| V2299 |
Specialty bifocal (by report) |
58 |
31 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
76 |
29 |
$2K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
34 |
17 |
$840.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
12 |
12 |
$828.50 |
| V2799 |
Vision item or service, miscellaneous |
16 |
16 |
$155.00 |
| 92340 |
|
12 |
12 |
$120.00 |
| 92015 |
|
14 |
14 |
$80.00 |