| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
8,401 |
7,995 |
$203K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,137 |
4,865 |
$109K |
| V2100 |
Lens spher single plano 4.00 |
2,974 |
2,869 |
$62K |
| V2784 |
Lens polycarb or equal |
3,713 |
3,670 |
$45K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,032 |
1,027 |
$41K |
| V2025 |
Eyeglasses delux frames |
2,033 |
2,033 |
$18K |
| V2200 |
Lens spher bifoc plano 4.00d |
386 |
376 |
$14K |
| V2520 |
Contact lens hydrophilic |
115 |
109 |
$11K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
423 |
407 |
$8K |
| V2107 |
Spherocylinder 4.25d/12-2d |
312 |
309 |
$7K |
| V2750 |
Anti-reflective coating |
1,745 |
1,725 |
$4K |
| V2781 |
Progressive lens per lens |
65 |
65 |
$2K |
| V2744 |
Tint photochromatic lens/es |
334 |
333 |
$1K |
| V2799 |
Misc vision item or service |
77 |
60 |
$0.00 |