| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
36,374 |
35,898 |
$1.04M |
| 92340 |
|
24,646 |
24,334 |
$485K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
17,461 |
16,536 |
$282K |
| 92341 |
|
5,797 |
5,708 |
$129K |
| V2100 |
Lens spher single plano 4.00 |
9,080 |
8,845 |
$116K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
4,654 |
4,134 |
$75K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
3,225 |
3,080 |
$49K |
| V2784 |
Lens polycarb or equal |
17,675 |
17,472 |
$46K |
| V2107 |
Spherocylinder 4.25d/12-2d |
2,503 |
2,415 |
$38K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,913 |
1,853 |
$32K |
| 92342 |
|
1,348 |
1,336 |
$32K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
1,030 |
931 |
$21K |
| V2781 |
Progressive lens per lens |
161 |
161 |
$9K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
357 |
349 |
$4K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
215 |
208 |
$3K |
| V2300 |
Lens sphere trifocal 4.00d |
66 |
66 |
$1K |
| V2101 |
Single visn sphere 4.12-7.00 |
52 |
52 |
$576.10 |
| V2102 |
Singl visn sphere 7.12-20.00 |
26 |
26 |
$400.82 |
| V2744 |
Tint photochromatic lens/es |
228 |
228 |
$239.00 |
| V2715 |
Prism lens/es |
44 |
44 |
$218.46 |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
12 |
12 |
$192.06 |
| V2756 |
Eye glass case |
554 |
548 |
$69.66 |
| V2750 |
Anti-reflective coating |
664 |
663 |
$0.00 |