| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylindr 4.00d/12-2.00d |
65,874 |
59,879 |
$642K |
| V2020 |
Vision svcs frames purchases |
107,414 |
97,161 |
$511K |
| V2100 |
Lens spher single plano 4.00 |
23,778 |
21,584 |
$205K |
| A9901 |
Delivery/set up/dispensing |
71,676 |
67,743 |
$189K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
14,393 |
13,093 |
$122K |
| V2797 |
Vis item/svc in other code |
37,646 |
26,334 |
$111K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
8,083 |
6,763 |
$95K |
| V2107 |
Spherocylinder 4.25d/12-2d |
8,392 |
7,527 |
$72K |
| V2784 |
Lens polycarb or equal |
29,842 |
23,851 |
$47K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
3,041 |
2,764 |
$25K |
| V2200 |
Lens spher bifoc plano 4.00d |
2,586 |
2,162 |
$25K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
2,539 |
2,278 |
$20K |
| V2101 |
Single visn sphere 4.12-7.00 |
1,987 |
1,798 |
$15K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
1,301 |
1,165 |
$11K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
690 |
565 |
$6K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
457 |
386 |
$5K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
464 |
417 |
$4K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
376 |
345 |
$3K |
| V2025 |
Eyeglasses delux frames |
1,240 |
940 |
$3K |
| V2102 |
Singl visn sphere 7.12-20.00 |
26 |
26 |
$216.00 |
| V2114 |
Spherocylinder over 12.00d |
13 |
13 |
$114.00 |
| V2760 |
Scratch resistant coating |
15 |
15 |
$0.00 |