| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens polycarb or equal |
48,331 |
23,296 |
$1.57M |
| V2100 |
Lens spher single plano 4.00 |
49,995 |
24,079 |
$1.47M |
| V2020 |
Vision svcs frames purchases |
43,368 |
29,206 |
$863K |
| 92014 |
|
13,031 |
12,826 |
$589K |
| 92004 |
|
6,674 |
6,535 |
$313K |
| 92012 |
|
5,913 |
5,805 |
$230K |
| V2200 |
Lens spher bifoc plano 4.00d |
3,199 |
1,935 |
$128K |
| 92002 |
|
3,222 |
3,163 |
$125K |
| 92015 |
|
18,018 |
17,720 |
$83K |
| V2101 |
Single visn sphere 4.12-7.00 |
1,897 |
1,050 |
$62K |
| V2744 |
Tint photochromatic lens/es |
2,013 |
1,007 |
$58K |
| V2299 |
Lens bifocal speciality |
1,458 |
717 |
$54K |
| V2750 |
Anti-reflective coating |
3,044 |
1,470 |
$48K |
| V2781 |
Progressive lens per lens |
1,511 |
767 |
$47K |
| V2500 |
Contact lens pmma spherical |
324 |
324 |
$19K |
| V2760 |
Scratch resistant coating |
1,388 |
583 |
$12K |
| 92310 |
|
136 |
135 |
$7K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
162 |
64 |
$4K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
96 |
39 |
$3K |
| V2025 |
Eyeglasses delux frames |
160 |
151 |
$2K |
| S0620 |
Routine ophthalmological exa |
28 |
28 |
$840.00 |