| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
10,665 |
10,034 |
$174K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,035 |
4,762 |
$71K |
| V2784 |
Lens polycarb or equal |
4,290 |
3,961 |
$51K |
| V2750 |
Anti-reflective coating |
2,553 |
2,284 |
$37K |
| V2781 |
Progressive lens per lens |
1,372 |
1,242 |
$28K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,181 |
1,114 |
$22K |
| V2100 |
Lens spher single plano 4.00 |
1,434 |
1,366 |
$17K |
| V2744 |
Tint photochromatic lens/es |
1,078 |
970 |
$14K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
897 |
839 |
$12K |
| V2107 |
Spherocylinder 4.25d/12-2d |
622 |
585 |
$8K |
| V2702 |
Deluxe lens feature |
534 |
480 |
$4K |
| V2200 |
Lens spher bifoc plano 4.00d |
235 |
216 |
$3K |
| S0500 |
Dispos cont lens |
20 |
20 |
$2K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
166 |
155 |
$2K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
153 |
143 |
$2K |
| V2101 |
Single visn sphere 4.12-7.00 |
62 |
58 |
$731.03 |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
47 |
44 |
$709.43 |
| V2799 |
Misc vision item or service |
350 |
309 |
$691.75 |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
58 |
52 |
$679.51 |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
32 |
29 |
$597.77 |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
24 |
24 |
$457.81 |