| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
11,272 |
10,241 |
$226K |
| 92014 |
|
2,468 |
2,467 |
$123K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,983 |
5,344 |
$117K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
2,220 |
2,201 |
$90K |
| 92004 |
|
1,497 |
1,496 |
$74K |
| V2100 |
Lens spher single plano 4.00 |
2,010 |
1,774 |
$38K |
| V2784 |
Lens polycarb or equal |
2,523 |
2,488 |
$35K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,079 |
944 |
$19K |
| V2200 |
Lens spher bifoc plano 4.00d |
301 |
297 |
$10K |
| V2107 |
Spherocylinder 4.25d/12-2d |
503 |
441 |
$8K |
| V2025 |
Eyeglasses delux frames |
775 |
775 |
$6K |
| V2750 |
Anti-reflective coating |
474 |
430 |
$3K |
| V2410 |
Lens variab asphericity sing |
12 |
12 |
$708.00 |
| V2781 |
Progressive lens per lens |
16 |
16 |
$382.00 |
| V2744 |
Tint photochromatic lens/es |
39 |
39 |
$96.90 |
| V2755 |
Uv lens/es |
12 |
12 |
$96.00 |
| V2799 |
Misc vision item or service |
323 |
286 |
$10.00 |
| 3072F |
|
148 |
148 |
$0.00 |
| 92015 |
|
3,422 |
3,420 |
$0.00 |
| 2022F |
|
55 |
55 |
$0.00 |