| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,912 |
6,169 |
$267K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,424 |
3,041 |
$174K |
| V2755 |
U-v lens, per lens |
4,922 |
4,358 |
$99K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
3,807 |
3,406 |
$48K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
588 |
525 |
$42K |
| 92370 |
|
1,031 |
948 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
266 |
228 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
204 |
175 |
$12K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$851.42 |
| V2715 |
Prism, per lens |
46 |
43 |
$706.19 |
| V2756 |
Eye glass case |
24 |
21 |
$0.00 |