| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
39,371 |
38,714 |
$1.30M |
| V2784 |
Lens polycarb or equal |
32,823 |
31,481 |
$1.25M |
| 92014 |
|
15,743 |
15,480 |
$1.11M |
| 92004 |
|
10,524 |
10,341 |
$928K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
27,968 |
26,748 |
$642K |
| V2744 |
Tint photochromatic lens/es |
5,706 |
5,602 |
$167K |
| 92015 |
|
31,125 |
30,434 |
$141K |
| V2100 |
Lens spher single plano 4.00 |
4,533 |
4,413 |
$100K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
3,415 |
3,346 |
$83K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,525 |
1,074 |
$47K |
| V2107 |
Spherocylinder 4.25d/12-2d |
1,329 |
1,262 |
$39K |
| V2781 |
Progressive lens per lens |
507 |
250 |
$9K |
| 92250 |
|
419 |
401 |
$7K |
| 99214 |
|
42 |
41 |
$4K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
181 |
85 |
$4K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
17 |
17 |
$510.36 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
13 |
12 |
$60.00 |