| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
|
6,697 |
6,687 |
$122K |
| V2020 |
Vision svcs frames purchases |
17,671 |
17,517 |
$55K |
| V2200 |
Lens spher bifoc plano 4.00d |
6,445 |
3,774 |
$25K |
| V2100 |
Lens spher single plano 4.00 |
13,978 |
7,424 |
$14K |
| V2784 |
Lens polycarb or equal |
10,453 |
5,629 |
$10K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,864 |
3,279 |
$10K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
2,846 |
1,635 |
$8K |
| 99203 |
|
30 |
30 |
$2K |
| 92250 |
|
43 |
43 |
$2K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
496 |
260 |
$236.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
59 |
29 |
$21.00 |
| V2744 |
Tint photochromatic lens/es |
2,387 |
1,205 |
$0.00 |
| V2299 |
Lens bifocal speciality |
480 |
242 |
$0.00 |
| V2781 |
Progressive lens per lens |
854 |
428 |
$0.00 |
| V2599 |
Contact lens/es other type |
12 |
12 |
$0.00 |
| V2500 |
Contact lens pmma spherical |
25 |
25 |
$0.00 |
| V2750 |
Anti-reflective coating |
1,780 |
910 |
$0.00 |
| V2760 |
Scratch resistant coating |
70 |
36 |
$0.00 |