| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
7,612 |
4,811 |
$78K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,253 |
2,669 |
$49K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
423 |
297 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
300 |
233 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
16 |
15 |
$304.50 |
| V2781 |
Progressive lens, per lens |
24 |
12 |
$0.00 |