| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Lens spher single plano 4.00 |
16,170 |
7,325 |
$509K |
| 92014 |
|
10,824 |
10,637 |
$434K |
| V2020 |
Vision svcs frames purchases |
11,186 |
9,435 |
$413K |
| V2200 |
Lens spher bifoc plano 4.00d |
2,247 |
1,264 |
$96K |
| 92004 |
|
786 |
761 |
$32K |
| V2744 |
Tint photochromatic lens/es |
776 |
409 |
$21K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
672 |
280 |
$18K |
| 92012 |
|
448 |
447 |
$18K |
| V2781 |
Progressive lens per lens |
671 |
363 |
$15K |
| V2299 |
Lens bifocal speciality |
391 |
186 |
$14K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
148 |
75 |
$5K |
| V2784 |
Lens polycarb or equal |
10,070 |
3,702 |
$4K |
| V2025 |
Eyeglasses delux frames |
322 |
310 |
$4K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
79 |
35 |
$2K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
26 |
14 |
$720.00 |
| V2750 |
Anti-reflective coating |
23 |
13 |
$297.00 |
| 2022F |
|
143 |
142 |
$0.00 |