| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
31,111 |
30,129 |
$127K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
29,535 |
16,943 |
$109K |
| V2100 |
Lens spher single plano 4.00 |
14,143 |
8,849 |
$53K |
| V2784 |
Lens polycarb or equal |
26,353 |
13,084 |
$49K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
8,254 |
4,766 |
$45K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
3,413 |
2,315 |
$16K |
| V2200 |
Lens spher bifoc plano 4.00d |
2,725 |
1,887 |
$15K |
| V2107 |
Spherocylinder 4.25d/12-2d |
2,854 |
1,906 |
$13K |
| V2101 |
Single visn sphere 4.12-7.00 |
820 |
595 |
$4K |
| V2744 |
Tint photochromatic lens/es |
1,393 |
696 |
$3K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
485 |
319 |
$3K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
442 |
339 |
$3K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
525 |
390 |
$2K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
456 |
324 |
$2K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
280 |
186 |
$2K |
| V2715 |
Prism lens/es |
472 |
272 |
$406.00 |
| V2745 |
Tint, any color/solid/grad |
71 |
70 |
$14.00 |
| V2750 |
Anti-reflective coating |
1,066 |
1,050 |
$8.00 |
| V2781 |
Progressive lens per lens |
1,222 |
601 |
$0.00 |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
86 |
43 |
$0.00 |