| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92002 |
|
8,048 |
8,026 |
$280K |
| V2100 |
Lens spher single plano 4.00 |
13,618 |
13,584 |
$192K |
| V2020 |
Vision svcs frames purchases |
18,002 |
17,976 |
$177K |
| 92340 |
|
12,173 |
12,144 |
$152K |
| 92004 |
|
2,878 |
2,874 |
$116K |
| V2200 |
Lens spher bifoc plano 4.00d |
2,185 |
2,181 |
$41K |
| 92341 |
|
2,246 |
2,240 |
$37K |
| V2784 |
Lens polycarb or equal |
2,567 |
2,564 |
$30K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,868 |
2,863 |
$23K |
| 92012 |
|
335 |
335 |
$13K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
542 |
541 |
$9K |
| 92014 |
|
109 |
109 |
$4K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
525 |
524 |
$4K |
| V2107 |
Spherocylinder 4.25d/12-2d |
347 |
345 |
$4K |
| V2101 |
Single visn sphere 4.12-7.00 |
99 |
98 |
$1K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
38 |
38 |
$697.50 |
| 92015 |
|
156 |
153 |
$360.00 |
| V2025 |
Eyeglasses delux frames |
185 |
185 |
$0.00 |