| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
9,959 |
9,445 |
$238K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,190 |
3,976 |
$85K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
661 |
647 |
$31K |
| V2100 |
Lens spher single plano 4.00 |
1,562 |
1,469 |
$29K |
| V2781 |
Progressive lens per lens |
429 |
426 |
$11K |
| V2784 |
Lens polycarb or equal |
816 |
805 |
$10K |
| V2523 |
Cntct lens hydrophil extend |
86 |
82 |
$7K |
| V2200 |
Lens spher bifoc plano 4.00d |
148 |
140 |
$6K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
281 |
275 |
$5K |
| V2107 |
Spherocylinder 4.25d/12-2d |
215 |
214 |
$4K |
| V2750 |
Anti-reflective coating |
537 |
536 |
$4K |
| V2521 |
Cntct lens hydrophilic toric |
25 |
24 |
$2K |
| V2744 |
Tint photochromatic lens/es |
127 |
126 |
$1K |
| V2520 |
Contact lens hydrophilic |
12 |
12 |
$818.86 |
| V2799 |
Misc vision item or service |
123 |
117 |
$447.00 |
| V2755 |
Uv lens/es |
26 |
26 |
$180.00 |