| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens polycarb or equal |
269,533 |
265,892 |
$4.72M |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
176,427 |
174,439 |
$3.64M |
| V2020 |
Vision svcs frames purchases |
287,796 |
283,498 |
$2.48M |
| V2100 |
Lens spher single plano 4.00 |
68,954 |
67,902 |
$1.13M |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
48,579 |
48,028 |
$878K |
| V2780 |
Oversize lens/es |
18,757 |
18,405 |
$341K |
| V2799 |
Misc vision item or service |
36,851 |
36,647 |
$285K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
12,194 |
11,858 |
$283K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
12,524 |
12,368 |
$228K |
| V2107 |
Spherocylinder 4.25d/12-2d |
19,149 |
18,886 |
$182K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
2,894 |
2,843 |
$142K |
| V2025 |
Eyeglasses delux frames |
3,653 |
3,602 |
$127K |
| 92014 |
|
3,294 |
3,215 |
$122K |
| V2200 |
Lens spher bifoc plano 4.00d |
5,223 |
4,992 |
$97K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
7,892 |
7,799 |
$94K |
| 92004 |
|
1,652 |
1,621 |
$61K |
| V2101 |
Single visn sphere 4.12-7.00 |
4,141 |
4,087 |
$38K |
| V2750 |
Anti-reflective coating |
2,600 |
1,847 |
$35K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
2,551 |
2,502 |
$32K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
2,472 |
2,446 |
$28K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
1,205 |
1,161 |
$22K |
| 92340 |
|
2,130 |
2,115 |
$21K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
1,109 |
1,086 |
$19K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
1,554 |
1,531 |
$18K |
| V2715 |
Prism lens/es |
3,147 |
3,092 |
$18K |
| 92002 |
|
463 |
460 |
$17K |
| V2520 |
Contact lens hydrophilic |
129 |
123 |
$13K |
| S0500 |
Dispos cont lens |
106 |
106 |
$10K |
| 92310 |
|
473 |
468 |
$9K |
| V2744 |
Tint photochromatic lens/es |
353 |
231 |
$7K |
| V2106 |
Spherocylinder 4.00d/>6.00d |
252 |
248 |
$6K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
114 |
110 |
$5K |
| 92012 |
|
76 |
74 |
$3K |
| V2208 |
Lens sphcy bifocal 4.25-7/2. |
68 |
67 |
$997.00 |
| V2102 |
Singl visn sphere 7.12-20.00 |
41 |
37 |
$661.50 |
| 92015 |
|
3,827 |
3,782 |
$0.00 |
| 92250 |
|
43 |
43 |
$0.00 |