| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
668 |
666 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
372 |
371 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
86 |
85 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
151 |
150 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
52 |
52 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
55 |
55 |
$921.00 |
| V2781 |
Progressive lens, per lens |
28 |
28 |
$781.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$477.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$50.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
36 |
36 |
$42.94 |
| V2750 |
Anti-reflective coating, per lens |
91 |
91 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
24 |
24 |
$0.00 |
| V2755 |
U-v lens, per lens |
13 |
13 |
$0.00 |