| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,249 |
6,174 |
$129K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,978 |
3,934 |
$79K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,400 |
1,387 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,199 |
1,186 |
$21K |
| V2750 |
Anti-reflective coating, per lens |
2,403 |
2,385 |
$9K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
219 |
217 |
$4K |
| V2744 |
Tint, photochromatic, per lens |
561 |
559 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
238 |
237 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
40 |
40 |
$651.50 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
13 |
13 |
$462.00 |
| V2799 |
Vision item or service, miscellaneous |
718 |
638 |
$101.43 |