| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
9,202 |
8,587 |
$219K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,488 |
5,096 |
$105K |
| V2100 |
Lens spher single plano 4.00 |
2,325 |
2,213 |
$44K |
| V2784 |
Lens polycarb or equal |
3,055 |
3,009 |
$43K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
964 |
962 |
$35K |
| V2750 |
Anti-reflective coating |
2,236 |
2,166 |
$11K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
524 |
488 |
$9K |
| V2025 |
Eyeglasses delux frames |
911 |
911 |
$8K |
| V2200 |
Lens spher bifoc plano 4.00d |
214 |
209 |
$7K |
| V2107 |
Spherocylinder 4.25d/12-2d |
263 |
254 |
$5K |
| V2520 |
Contact lens hydrophilic |
66 |
61 |
$5K |
| V2521 |
Cntct lens hydrophilic toric |
12 |
12 |
$1K |
| V2781 |
Progressive lens per lens |
34 |
33 |
$810.50 |
| V2744 |
Tint photochromatic lens/es |
289 |
277 |
$555.70 |
| V2755 |
Uv lens/es |
12 |
12 |
$96.00 |
| V2799 |
Misc vision item or service |
207 |
183 |
$31.16 |