| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
715,213 |
699,269 |
$18.30M |
| V2100 |
Lens spher single plano 4.00 |
595,466 |
580,798 |
$12.61M |
| V2784 |
Lens polycarb or equal |
275,906 |
262,496 |
$4.76M |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
25,202 |
23,653 |
$2.35M |
| V2750 |
Anti-reflective coating |
58,858 |
55,745 |
$1.57M |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
57,943 |
57,653 |
$1.13M |
| V2744 |
Tint photochromatic lens/es |
26,391 |
24,840 |
$622K |
| 66984 |
|
2,858 |
2,274 |
$509K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
15,630 |
15,547 |
$375K |
| 92014 |
|
8,936 |
8,935 |
$52K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
1,264 |
1,261 |
$46K |
| 66821 |
|
408 |
369 |
$33K |
| 92136 |
|
865 |
780 |
$22K |
| 92004 |
|
3,032 |
3,032 |
$17K |
| V2107 |
Spherocylinder 4.25d/12-2d |
479 |
479 |
$15K |
| V2200 |
Lens spher bifoc plano 4.00d |
989 |
900 |
$11K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
41 |
41 |
$3K |
| V2781 |
Progressive lens per lens |
344 |
327 |
$3K |
| 92012 |
|
84 |
84 |
$3K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
61 |
61 |
$2K |
| V2799 |
Misc vision item or service |
641 |
611 |
$1K |
| V2755 |
Uv lens/es |
1,025 |
815 |
$605.22 |
| 92015 |
|
394 |
394 |
$285.00 |
| V2300 |
Lens sphere trifocal 4.00d |
13 |
13 |
$0.00 |
| V2760 |
Scratch resistant coating |
12 |
12 |
$0.00 |
| V2702 |
Deluxe lens feature |
13 |
13 |
$0.00 |