| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
13,236 |
11,966 |
$361K |
| 92340 |
|
12,118 |
11,300 |
$334K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
7,850 |
7,067 |
$135K |
| V2784 |
Lens polycarb or equal |
10,308 |
9,257 |
$77K |
| 92370 |
|
1,829 |
1,699 |
$47K |
| V2100 |
Lens spher single plano 4.00 |
2,243 |
2,053 |
$33K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,750 |
1,603 |
$29K |
| V2760 |
Scratch resistant coating |
10,053 |
9,016 |
$18K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
233 |
211 |
$11K |
| V2781 |
Progressive lens per lens |
249 |
236 |
$9K |
| V2107 |
Spherocylinder 4.25d/12-2d |
308 |
285 |
$5K |
| 92014 |
|
83 |
82 |
$2K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
44 |
42 |
$748.80 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
13 |
13 |
$213.25 |
| 92015 |
|
94 |
94 |
$0.00 |
| 99199 |
|
70 |
63 |
$0.00 |
| 92004 |
|
28 |
28 |
$0.00 |