| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
6,474 |
6,352 |
$227K |
| 92004 |
|
2,161 |
2,150 |
$197K |
| V2784 |
Lens polycarb or equal |
4,442 |
4,015 |
$192K |
| 92014 |
|
2,239 |
2,222 |
$154K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,793 |
1,652 |
$59K |
| V2100 |
Lens spher single plano 4.00 |
2,153 |
2,108 |
$31K |
| 92015 |
|
5,546 |
5,508 |
$27K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
570 |
317 |
$18K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
382 |
365 |
$15K |
| 92012 |
|
320 |
320 |
$10K |
| 92002 |
|
310 |
310 |
$10K |
| V2200 |
Lens spher bifoc plano 4.00d |
212 |
196 |
$4K |
| V2300 |
Lens sphere trifocal 4.00d |
75 |
73 |
$2K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
18 |
12 |
$1K |
| V2781 |
Progressive lens per lens |
31 |
14 |
$997.88 |
| V2107 |
Spherocylinder 4.25d/12-2d |
15 |
13 |
$695.88 |