| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Eyeglasses delux frames |
5,454 |
5,396 |
$160K |
| V2100 |
Lens spher single plano 4.00 |
4,577 |
4,513 |
$57K |
| V2020 |
Vision svcs frames purchases |
1,568 |
1,511 |
$32K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,384 |
1,356 |
$25K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
289 |
285 |
$4K |
| V2200 |
Lens spher bifoc plano 4.00d |
234 |
223 |
$4K |
| V2744 |
Tint photochromatic lens/es |
33 |
31 |
$632.52 |
| V2799 |
Misc vision item or service |
613 |
601 |
$310.03 |
| V2750 |
Anti-reflective coating |
743 |
737 |
$0.00 |
| V2781 |
Progressive lens per lens |
76 |
76 |
$0.00 |