| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
9,959 |
9,445 |
$238K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,190 |
3,976 |
$85K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
661 |
647 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,562 |
1,469 |
$29K |
| V2781 |
Progressive lens, per lens |
429 |
426 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
816 |
805 |
$10K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
86 |
82 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
148 |
140 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
281 |
275 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
215 |
214 |
$4K |
| V2750 |
Anti-reflective coating, per lens |
537 |
536 |
$4K |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
25 |
24 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
127 |
126 |
$1K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
12 |
12 |
$818.86 |
| V2799 |
Vision item or service, miscellaneous |
123 |
117 |
$447.00 |
| V2755 |
U-v lens, per lens |
26 |
26 |
$180.00 |