| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens polycarb or equal |
6,717 |
3,248 |
$204K |
| 92014 |
|
3,327 |
3,269 |
$149K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
2,075 |
961 |
$93K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,809 |
2,040 |
$68K |
| 92004 |
|
785 |
773 |
$45K |
| V2020 |
Vision svcs frames purchases |
3,818 |
3,612 |
$27K |
| V2100 |
Lens spher single plano 4.00 |
1,724 |
975 |
$26K |
| 92015 |
|
3,603 |
3,534 |
$20K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
795 |
438 |
$17K |
| 92083 |
|
145 |
144 |
$8K |
| 92310 |
|
181 |
175 |
$7K |
| 92020 |
|
533 |
531 |
$7K |
| 99214 |
|
93 |
92 |
$4K |
| 92133 |
|
133 |
132 |
$4K |
| V2200 |
Lens spher bifoc plano 4.00d |
187 |
91 |
$4K |
| 92134 |
|
120 |
119 |
$3K |
| 99213 |
|
103 |
94 |
$3K |
| 92250 |
|
69 |
68 |
$3K |
| V2025 |
Eyeglasses delux frames |
418 |
416 |
$3K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
161 |
101 |
$3K |
| V2302 |
Lens sphere trifocal 7.12-20 |
24 |
12 |
$600.00 |
| V2101 |
Single visn sphere 4.12-7.00 |
24 |
13 |
$420.00 |
| 92012 |
|
12 |
12 |
$323.51 |
| V2781 |
Progressive lens per lens |
39 |
24 |
$0.00 |