| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
7,818 |
7,624 |
$178K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,548 |
4,464 |
$86K |
| V2784 |
Lens polycarb or equal |
2,871 |
2,849 |
$51K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,217 |
1,214 |
$42K |
| V2100 |
Lens spher single plano 4.00 |
1,851 |
1,788 |
$33K |
| V2750 |
Anti-reflective coating |
1,621 |
1,598 |
$15K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
679 |
676 |
$11K |
| V2107 |
Spherocylinder 4.25d/12-2d |
451 |
451 |
$8K |
| V2025 |
Eyeglasses delux frames |
828 |
827 |
$8K |
| V2744 |
Tint photochromatic lens/es |
314 |
311 |
$2K |
| V2410 |
Lens variab asphericity sing |
24 |
24 |
$1K |
| V2200 |
Lens spher bifoc plano 4.00d |
15 |
15 |
$380.30 |
| V2781 |
Progressive lens per lens |
13 |
13 |
$203.00 |
| V2799 |
Misc vision item or service |
28 |
26 |
$0.00 |