| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens polycarb or equal |
12,249 |
11,793 |
$249K |
| V2020 |
Vision svcs frames purchases |
11,491 |
11,458 |
$159K |
| V2520 |
Contact lens hydrophilic |
2,424 |
2,423 |
$144K |
| V2100 |
Lens spher single plano 4.00 |
6,258 |
6,098 |
$81K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,393 |
4,219 |
$51K |
| V2521 |
Cntct lens hydrophilic toric |
534 |
534 |
$33K |
| V2101 |
Single visn sphere 4.12-7.00 |
1,123 |
1,098 |
$14K |
| V2107 |
Spherocylinder 4.25d/12-2d |
1,185 |
1,155 |
$13K |
| 92340 |
|
230 |
230 |
$4K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
108 |
108 |
$1K |
| V2102 |
Singl visn sphere 7.12-20.00 |
29 |
28 |
$462.00 |
| V2500 |
Contact lens pmma spherical |
160 |
160 |
$100.00 |
| V2025 |
Eyeglasses delux frames |
126 |
126 |
$0.00 |
| V2750 |
Anti-reflective coating |
109 |
109 |
$0.00 |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
15 |
15 |
$0.00 |