| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
9,202 |
8,587 |
$219K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,488 |
5,096 |
$105K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,325 |
2,213 |
$44K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,055 |
3,009 |
$43K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
964 |
962 |
$35K |
| V2750 |
Anti-reflective coating, per lens |
2,236 |
2,166 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
524 |
488 |
$9K |
| V2025 |
Deluxe frame |
911 |
911 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
214 |
209 |
$7K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
263 |
254 |
$5K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
66 |
61 |
$5K |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
12 |
12 |
$1K |
| V2781 |
Progressive lens, per lens |
34 |
33 |
$810.50 |
| V2744 |
Tint, photochromatic, per lens |
289 |
277 |
$555.70 |
| V2755 |
U-v lens, per lens |
12 |
12 |
$96.00 |
| V2799 |
Vision item or service, miscellaneous |
207 |
183 |
$31.16 |