| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
12,505 |
12,254 |
$757K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
7,962 |
7,790 |
$173K |
| V2100 |
Lens spher single plano 4.00 |
3,820 |
3,761 |
$75K |
| V2107 |
Spherocylinder 4.25d/12-2d |
1,129 |
1,119 |
$24K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,031 |
1,013 |
$20K |
| V2781 |
Progressive lens per lens |
45 |
45 |
$931.00 |
| V2101 |
Single visn sphere 4.12-7.00 |
30 |
30 |
$539.50 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
16 |
14 |
$238.50 |
| V2744 |
Tint photochromatic lens/es |
601 |
596 |
$0.00 |
| V2784 |
Lens polycarb or equal |
64 |
62 |
$0.00 |
| V2799 |
Misc vision item or service |
124 |
119 |
$0.00 |
| V2750 |
Anti-reflective coating |
5,291 |
5,168 |
$0.00 |