| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
5,000 |
4,612 |
$148K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,274 |
2,005 |
$50K |
| V2100 |
Lens spher single plano 4.00 |
1,373 |
1,285 |
$29K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
665 |
661 |
$27K |
| V2784 |
Lens polycarb or equal |
1,409 |
1,371 |
$16K |
| V2200 |
Lens spher bifoc plano 4.00d |
340 |
331 |
$13K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
357 |
312 |
$7K |
| V2025 |
Eyeglasses delux frames |
202 |
202 |
$1K |
| V2107 |
Spherocylinder 4.25d/12-2d |
67 |
67 |
$1K |
| V2521 |
Cntct lens hydrophilic toric |
13 |
13 |
$1K |
| V2744 |
Tint photochromatic lens/es |
85 |
85 |
$452.20 |
| V2750 |
Anti-reflective coating |
139 |
139 |
$0.00 |
| V2799 |
Misc vision item or service |
29 |
28 |
$0.00 |