| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
12,185 |
12,100 |
$241K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
6,316 |
6,258 |
$137K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,704 |
3,644 |
$136K |
| V2025 |
Deluxe frame |
2,585 |
2,578 |
$84K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,884 |
2,871 |
$77K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
2,613 |
2,590 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,632 |
1,616 |
$29K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
494 |
489 |
$16K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
569 |
567 |
$15K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
587 |
581 |
$11K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
195 |
195 |
$3K |
| V2109 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens |
12 |
12 |
$385.52 |