| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
12,804 |
12,352 |
$444K |
| 92340 |
|
10,829 |
10,713 |
$207K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,275 |
5,158 |
$106K |
| V2100 |
Lens spher single plano 4.00 |
3,780 |
3,700 |
$105K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,502 |
1,382 |
$100K |
| V2784 |
Lens polycarb or equal |
5,885 |
5,805 |
$85K |
| V2025 |
Eyeglasses delux frames |
1,594 |
1,582 |
$49K |
| 92341 |
|
1,038 |
1,006 |
$34K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,623 |
1,609 |
$34K |
| V2107 |
Spherocylinder 4.25d/12-2d |
509 |
502 |
$11K |
| V2200 |
Lens spher bifoc plano 4.00d |
187 |
187 |
$9K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
39 |
39 |
$807.20 |
| V2750 |
Anti-reflective coating |
29 |
29 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
12 |
12 |
$0.00 |