| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
751,645 |
718,295 |
$6.73M |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
469,548 |
449,061 |
$4.10M |
| S0581 |
Nonstnd lens |
172,698 |
87,688 |
$3.07M |
| V2100 |
Lens spher single plano 4.00 |
185,826 |
177,837 |
$1.48M |
| S0580 |
Polycarb lens |
62,182 |
59,550 |
$1.38M |
| V2025 |
Eyeglasses delux frames |
31,324 |
29,720 |
$1.32M |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
142,063 |
135,981 |
$1.09M |
| V2510 |
Cntct gas permeable sphericl |
2,636 |
2,518 |
$540K |
| V2107 |
Spherocylinder 4.25d/12-2d |
54,728 |
52,238 |
$423K |
| V2521 |
Cntct lens hydrophilic toric |
1,723 |
1,700 |
$413K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
36,412 |
34,862 |
$265K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
21,106 |
20,154 |
$149K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
8,345 |
7,968 |
$140K |
| V2520 |
Contact lens hydrophilic |
705 |
695 |
$103K |
| V2200 |
Lens spher bifoc plano 4.00d |
5,954 |
5,698 |
$100K |
| V2101 |
Single visn sphere 4.12-7.00 |
13,126 |
12,576 |
$93K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
7,982 |
7,626 |
$66K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
7,004 |
6,701 |
$49K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
4,628 |
4,412 |
$36K |
| V2531 |
Contact lens gas permeable |
214 |
193 |
$36K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
1,939 |
1,847 |
$31K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
1,356 |
1,287 |
$20K |
| V2106 |
Spherocylinder 4.00d/>6.00d |
2,152 |
2,062 |
$15K |
| V2102 |
Singl visn sphere 7.12-20.00 |
1,234 |
1,175 |
$10K |
| V2715 |
Prism lens/es |
7,577 |
7,224 |
$7K |
| V2113 |
Spherocylindr 7.25d/4.25-6d |
342 |
323 |
$2K |
| V2208 |
Lens sphcy bifocal 4.25-7/2. |
111 |
108 |
$2K |
| V2211 |
Lens sphcy bifo 7.25-12/.25- |
76 |
68 |
$1K |
| V2744 |
Tint photochromatic lens/es |
25 |
24 |
$817.52 |
| V2110 |
Spherocylinder 4.25d/over 6d |
38 |
37 |
$253.92 |
| V2205 |
Lens sphcy bifocal 4.00d/4.2 |
14 |
13 |
$250.50 |