| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
332,725 |
329,104 |
$7.73M |
| V2784 |
Lens polycarb or equal |
228,739 |
225,973 |
$2.11M |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
112,803 |
111,725 |
$1.72M |
| V2200 |
Lens spher bifoc plano 4.00d |
50,875 |
50,222 |
$1.49M |
| V2430 |
Lens variable asphericity bi |
22,755 |
22,526 |
$1.28M |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
48,285 |
47,705 |
$1.25M |
| V2100 |
Lens spher single plano 4.00 |
54,876 |
54,276 |
$882K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
13,977 |
13,904 |
$238K |
| V2750 |
Anti-reflective coating |
7,175 |
7,092 |
$232K |
| V2107 |
Spherocylinder 4.25d/12-2d |
9,377 |
9,268 |
$171K |
| V2781 |
Progressive lens per lens |
2,372 |
2,359 |
$143K |
| V2710 |
Glass/plastic slab off prism |
3,191 |
3,145 |
$133K |
| V2744 |
Tint photochromatic lens/es |
6,632 |
6,521 |
$98K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
3,010 |
2,973 |
$98K |
| V2300 |
Lens sphere trifocal 4.00d |
2,431 |
2,392 |
$88K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
3,668 |
3,649 |
$71K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
2,072 |
2,061 |
$60K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
1,578 |
1,561 |
$45K |
| V2101 |
Single visn sphere 4.12-7.00 |
1,373 |
1,363 |
$20K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
528 |
526 |
$11K |
| V2220 |
Lens bifocal add over 3.25d |
260 |
258 |
$2K |
| V2205 |
Lens sphcy bifocal 4.00d/4.2 |
43 |
43 |
$1K |
| V2745 |
Tint, any color/solid/grad |
214 |
209 |
$803.39 |
| V2025 |
Eyeglasses delux frames |
12 |
12 |
$494.57 |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
13 |
13 |
$342.00 |
| V2219 |
Lens bifocal seg width over |
40 |
40 |
$203.00 |
| V2599 |
Contact lens/es other type |
33 |
29 |
$0.00 |
| 92326 |
|
34 |
30 |
$0.00 |