| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
11,717 |
11,171 |
$338K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
7,174 |
6,855 |
$149K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
2,418 |
2,396 |
$94K |
| V2784 |
Lens polycarb or equal |
4,640 |
4,588 |
$73K |
| V2100 |
Lens spher single plano 4.00 |
2,113 |
2,025 |
$40K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,321 |
1,241 |
$24K |
| V2025 |
Eyeglasses delux frames |
2,052 |
2,052 |
$19K |
| V2107 |
Spherocylinder 4.25d/12-2d |
813 |
777 |
$16K |
| V2200 |
Lens spher bifoc plano 4.00d |
353 |
346 |
$14K |
| V2750 |
Anti-reflective coating |
2,180 |
2,129 |
$11K |
| V2410 |
Lens variab asphericity sing |
94 |
94 |
$5K |
| V2744 |
Tint photochromatic lens/es |
843 |
834 |
$3K |
| V2430 |
Lens variable asphericity bi |
14 |
13 |
$1K |
| V2781 |
Progressive lens per lens |
28 |
28 |
$750.00 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
12 |
12 |
$232.00 |
| V2799 |
Misc vision item or service |
188 |
177 |
$22.00 |