| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
12,986 |
11,458 |
$258K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
7,508 |
6,558 |
$132K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
654 |
594 |
$18K |
| V2100 |
Lens spher single plano 4.00 |
1,007 |
959 |
$16K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
737 |
699 |
$12K |
| V2784 |
Lens polycarb or equal |
1,001 |
921 |
$7K |
| V2025 |
Eyeglasses delux frames |
102 |
86 |
$4K |
| V2107 |
Spherocylinder 4.25d/12-2d |
155 |
151 |
$3K |
| V2781 |
Progressive lens per lens |
62 |
60 |
$1K |
| 92002 |
|
14 |
14 |
$806.12 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
14 |
13 |
$277.40 |
| V2760 |
Scratch resistant coating |
330 |
319 |
$147.42 |