| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
6,142 |
5,970 |
$161K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,093 |
3,983 |
$80K |
| V2784 |
Lens polycarb or equal |
2,041 |
2,013 |
$31K |
| V2100 |
Lens spher single plano 4.00 |
1,220 |
1,192 |
$24K |
| V2025 |
Eyeglasses delux frames |
711 |
711 |
$6K |
| V2750 |
Anti-reflective coating |
1,235 |
1,215 |
$5K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
126 |
126 |
$5K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
159 |
144 |
$3K |
| V2520 |
Contact lens hydrophilic |
13 |
12 |
$2K |
| V2781 |
Progressive lens per lens |
24 |
24 |
$850.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
12 |
12 |
$572.50 |
| V2744 |
Tint photochromatic lens/es |
140 |
137 |
$548.90 |
| V2107 |
Spherocylinder 4.25d/12-2d |
25 |
25 |
$476.88 |
| V2799 |
Misc vision item or service |
16 |
15 |
$0.00 |