| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
5,626 |
4,909 |
$98K |
| V2100 |
Lens spher single plano 4.00 |
2,672 |
2,138 |
$19K |
| 92340 |
|
1,002 |
933 |
$14K |
| V2784 |
Lens polycarb or equal |
2,600 |
2,173 |
$9K |
| V2025 |
Eyeglasses delux frames |
272 |
246 |
$9K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,068 |
1,004 |
$7K |
| V2500 |
Contact lens pmma spherical |
266 |
133 |
$6K |
| V2750 |
Anti-reflective coating |
1,813 |
1,504 |
$772.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
45 |
34 |
$280.67 |
| V2520 |
Contact lens hydrophilic |
15 |
15 |
$209.98 |
| V2521 |
Cntct lens hydrophilic toric |
22 |
12 |
$141.01 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
13 |
13 |
$27.50 |
| 92342 |
|
28 |
14 |
$20.00 |
| V2744 |
Tint photochromatic lens/es |
24 |
13 |
$0.00 |
| V2799 |
Misc vision item or service |
255 |
187 |
$0.00 |
| 92004 |
|
44 |
44 |
$0.00 |
| V2781 |
Progressive lens per lens |
58 |
16 |
$0.00 |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
20 |
12 |
$0.00 |
| 92014 |
|
175 |
150 |
$0.00 |