| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
81,693 |
81,088 |
$440K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
62,890 |
37,006 |
$264K |
| V2100 |
Lens spher single plano 4.00 |
37,651 |
23,035 |
$158K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
23,650 |
13,629 |
$142K |
| V2784 |
Lens polycarb or equal |
54,132 |
26,954 |
$93K |
| V2200 |
Lens spher bifoc plano 4.00d |
9,024 |
5,941 |
$54K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
7,921 |
5,386 |
$33K |
| V2107 |
Spherocylinder 4.25d/12-2d |
7,367 |
4,864 |
$31K |
| V2101 |
Single visn sphere 4.12-7.00 |
2,954 |
2,043 |
$12K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
1,514 |
1,135 |
$9K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
1,062 |
525 |
$7K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
1,174 |
803 |
$7K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
1,310 |
898 |
$5K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
1,281 |
911 |
$5K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
1,171 |
895 |
$5K |
| V2102 |
Singl visn sphere 7.12-20.00 |
463 |
324 |
$2K |
| V2201 |
Lens sphere bifocal 4.12-7.0 |
300 |
235 |
$2K |
| V2799 |
Misc vision item or service |
449 |
222 |
$2K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
375 |
275 |
$2K |
| V2760 |
Scratch resistant coating |
479 |
476 |
$2K |
| V2211 |
Lens sphcy bifo 7.25-12/.25- |
213 |
147 |
$1K |
| V2220 |
Lens bifocal add over 3.25d |
70 |
40 |
$1K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
195 |
151 |
$827.15 |
| V2797 |
Vis item/svc in other code |
239 |
231 |
$733.00 |
| V2208 |
Lens sphcy bifocal 4.25-7/2. |
101 |
76 |
$598.90 |
| V2205 |
Lens sphcy bifocal 4.00d/4.2 |
87 |
69 |
$515.35 |
| V2700 |
Balance lens |
192 |
192 |
$479.00 |
| V2750 |
Anti-reflective coating |
2,650 |
2,611 |
$453.60 |
| V2114 |
Spherocylinder over 12.00d |
88 |
59 |
$363.05 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
56 |
28 |
$350.00 |
| V2730 |
Special base curve |
381 |
186 |
$244.00 |
| V2744 |
Tint photochromatic lens/es |
3,385 |
1,676 |
$109.30 |
| V2745 |
Tint, any color/solid/grad |
648 |
635 |
$69.00 |
| V2755 |
Uv lens/es |
16 |
16 |
$12.00 |
| V2781 |
Progressive lens per lens |
3,930 |
1,927 |
$0.00 |