| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylindr 4.00d/12-2.00d |
10,573 |
9,903 |
$250K |
| 92340 |
|
17,741 |
16,739 |
$164K |
| V2020 |
Vision svcs frames purchases |
14,576 |
13,752 |
$143K |
| V2100 |
Lens spher single plano 4.00 |
4,361 |
4,092 |
$93K |
| 92014 |
|
1,895 |
1,756 |
$72K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
2,966 |
2,767 |
$66K |
| 92004 |
|
848 |
794 |
$58K |
| V2107 |
Spherocylinder 4.25d/12-2d |
1,521 |
1,415 |
$43K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,285 |
1,220 |
$32K |
| 92341 |
|
1,658 |
1,581 |
$15K |
| V2599 |
Contact lens/es other type |
133 |
126 |
$14K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
386 |
355 |
$10K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
335 |
312 |
$7K |
| V2101 |
Single visn sphere 4.12-7.00 |
213 |
198 |
$6K |
| V2784 |
Lens polycarb or equal |
4,068 |
3,856 |
$5K |
| V2200 |
Lens spher bifoc plano 4.00d |
141 |
131 |
$5K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
70 |
65 |
$2K |
| 92310 |
|
107 |
103 |
$335.00 |
| 92015 |
|
2,798 |
2,602 |
$273.50 |
| 92342 |
|
46 |
46 |
$46.50 |
| V2756 |
Eye glass case |
45 |
45 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
308 |
299 |
$0.00 |
| V2799 |
Misc vision item or service |
13 |
13 |
$0.00 |
| V2750 |
Anti-reflective coating |
812 |
753 |
$0.00 |
| V2025 |
Eyeglasses delux frames |
6,114 |
5,845 |
$-147.00 |