| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
5,788 |
5,040 |
$146K |
| V2020 |
Vision svcs frames purchases |
8,380 |
7,521 |
$127K |
| V2100 |
Lens spher single plano 4.00 |
5,265 |
4,680 |
$104K |
| 92004 |
|
3,101 |
2,720 |
$73K |
| V2784 |
Lens polycarb or equal |
5,241 |
4,649 |
$61K |
| V2781 |
Progressive lens per lens |
1,217 |
1,112 |
$50K |
| V2299 |
Lens bifocal speciality |
1,219 |
1,114 |
$35K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,473 |
1,340 |
$28K |
| V2200 |
Lens spher bifoc plano 4.00d |
297 |
272 |
$9K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
77 |
62 |
$2K |
| V2102 |
Singl visn sphere 7.12-20.00 |
75 |
75 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
29 |
29 |
$597.12 |
| 92015 |
|
7,234 |
6,444 |
$0.00 |
| V2750 |
Anti-reflective coating |
2,457 |
2,187 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
442 |
413 |
$0.00 |