| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,043 |
5,278 |
$86K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,343 |
3,603 |
$79K |
| 92004 |
|
1,744 |
1,717 |
$62K |
| 92014 |
|
1,591 |
1,558 |
$54K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,724 |
3,186 |
$54K |
| 92310 |
|
454 |
450 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,203 |
1,043 |
$16K |
| 92002 |
|
275 |
274 |
$12K |
| V2300 |
Sphere, trifocal, plano to plus or minus 4.00d, per lens |
179 |
168 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
393 |
319 |
$5K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
132 |
114 |
$4K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
216 |
177 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
40 |
$350.00 |
| V2744 |
Tint, photochromatic, per lens |
40 |
39 |
$0.00 |
| V2755 |
U-v lens, per lens |
124 |
123 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
139 |
138 |
$0.00 |