| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
10,665 |
10,034 |
$174K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,035 |
4,762 |
$71K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,290 |
3,961 |
$51K |
| V2750 |
Anti-reflective coating, per lens |
2,553 |
2,284 |
$37K |
| V2781 |
Progressive lens, per lens |
1,372 |
1,242 |
$28K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,181 |
1,114 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,434 |
1,366 |
$17K |
| V2744 |
Tint, photochromatic, per lens |
1,078 |
970 |
$14K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
897 |
839 |
$12K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
622 |
585 |
$8K |
| V2702 |
Deluxe lens feature |
534 |
480 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
235 |
216 |
$3K |
| S0500 |
Disposable contact lens, per lens |
20 |
20 |
$2K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
166 |
155 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
153 |
143 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
62 |
58 |
$731.03 |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
47 |
44 |
$709.43 |
| V2799 |
Vision item or service, miscellaneous |
350 |
309 |
$691.75 |
| V2111 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens |
58 |
52 |
$679.51 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
32 |
29 |
$597.77 |
| V2207 |
Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens |
24 |
24 |
$457.81 |