| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
3,914 |
3,825 |
$73K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,313 |
2,285 |
$43K |
| V2750 |
Anti-reflective coating |
840 |
806 |
$10K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
550 |
540 |
$8K |
| V2100 |
Lens spher single plano 4.00 |
532 |
525 |
$7K |
| V2784 |
Lens polycarb or equal |
637 |
599 |
$7K |
| V2781 |
Progressive lens per lens |
246 |
220 |
$5K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
194 |
187 |
$4K |
| V2744 |
Tint photochromatic lens/es |
173 |
155 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
117 |
117 |
$2K |
| V2702 |
Deluxe lens feature |
89 |
75 |
$442.08 |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
15 |
15 |
$335.87 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
25 |
24 |
$298.95 |
| V2799 |
Misc vision item or service |
21 |
19 |
$55.93 |