| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Eyeglasses delux frames |
3,417 |
3,324 |
$355K |
| 92004 |
|
2,468 |
2,378 |
$266K |
| 92250 |
|
4,990 |
4,700 |
$242K |
| V2410 |
Lens variab asphericity sing |
3,260 |
3,189 |
$220K |
| 92014 |
|
2,307 |
2,148 |
$215K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,768 |
2,705 |
$145K |
| V2755 |
Uv lens/es |
3,407 |
3,323 |
$104K |
| V2750 |
Anti-reflective coating |
3,423 |
3,346 |
$90K |
| V2784 |
Lens polycarb or equal |
3,406 |
3,328 |
$75K |
| 92340 |
|
3,439 |
3,264 |
$65K |
| V2744 |
Tint photochromatic lens/es |
1,160 |
1,120 |
$21K |
| 99213 |
|
201 |
184 |
$12K |
| V2781 |
Progressive lens per lens |
108 |
107 |
$3K |
| 92015 |
|
4,900 |
4,696 |
$3K |
| V2020 |
Vision svcs frames purchases |
75 |
71 |
$3K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
12 |
12 |
$921.06 |
| V2100 |
Lens spher single plano 4.00 |
12 |
12 |
$558.48 |
| V2799 |
Misc vision item or service |
67 |
67 |
$0.00 |
| V2760 |
Scratch resistant coating |
2,634 |
2,588 |
$0.00 |