| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
4,088 |
3,878 |
$57K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,771 |
2,630 |
$42K |
| V2784 |
Lens polycarb or equal |
1,708 |
1,617 |
$21K |
| V2750 |
Anti-reflective coating |
1,933 |
1,836 |
$20K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
925 |
866 |
$12K |
| V2100 |
Lens spher single plano 4.00 |
730 |
693 |
$9K |
| V2799 |
Misc vision item or service |
1,164 |
1,090 |
$1K |
| V2744 |
Tint photochromatic lens/es |
45 |
41 |
$344.76 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
38 |
37 |
$297.66 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
13 |
12 |
$296.91 |
| V2702 |
Deluxe lens feature |
126 |
118 |
$276.91 |
| V2755 |
Uv lens/es |
28 |
25 |
$61.25 |