| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
8,000 |
7,448 |
$265K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,647 |
4,316 |
$88K |
| V2100 |
Lens spher single plano 4.00 |
1,657 |
1,536 |
$29K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
869 |
788 |
$29K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
678 |
637 |
$10K |
| V2107 |
Spherocylinder 4.25d/12-2d |
361 |
343 |
$6K |
| V2521 |
Cntct lens hydrophilic toric |
45 |
37 |
$3K |
| V2523 |
Cntct lens hydrophil extend |
41 |
37 |
$3K |
| V2520 |
Contact lens hydrophilic |
32 |
25 |
$3K |
| V2784 |
Lens polycarb or equal |
1,661 |
1,488 |
$2K |
| V2200 |
Lens spher bifoc plano 4.00d |
17 |
12 |
$360.00 |
| V2750 |
Anti-reflective coating |
1,867 |
1,738 |
$0.00 |
| V2799 |
Misc vision item or service |
67 |
65 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
318 |
286 |
$0.00 |