| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,916 |
7,745 |
$93K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
9,099 |
8,927 |
$75K |
| V2020 |
Frames, purchases |
9,976 |
9,779 |
$75K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
316 |
316 |
$18K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
980 |
971 |
$10K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
547 |
542 |
$10K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
66 |
66 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
46 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
305 |
299 |
$0.00 |