| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,000 |
4,612 |
$148K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,274 |
2,005 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,373 |
1,285 |
$29K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
665 |
661 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,409 |
1,371 |
$16K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
340 |
331 |
$13K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
357 |
312 |
$7K |
| V2025 |
Deluxe frame |
202 |
202 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
67 |
67 |
$1K |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
13 |
13 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
85 |
85 |
$452.20 |
| V2750 |
Anti-reflective coating, per lens |
139 |
139 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
29 |
28 |
$0.00 |