| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
12,185 |
12,100 |
$241K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
6,316 |
6,258 |
$137K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
3,704 |
3,644 |
$136K |
| V2025 |
Eyeglasses delux frames |
2,585 |
2,578 |
$84K |
| V2784 |
Lens polycarb or equal |
2,884 |
2,871 |
$77K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
2,613 |
2,590 |
$50K |
| V2100 |
Lens spher single plano 4.00 |
1,632 |
1,616 |
$29K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
494 |
489 |
$16K |
| V2200 |
Lens spher bifoc plano 4.00d |
569 |
567 |
$15K |
| V2107 |
Spherocylinder 4.25d/12-2d |
587 |
581 |
$11K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
195 |
195 |
$3K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
12 |
12 |
$385.52 |