| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
6,732 |
5,554 |
$180K |
| V2744 |
Tint photochromatic lens/es |
6,731 |
5,554 |
$152K |
| 92015 |
|
4,217 |
3,931 |
$144K |
| S0580 |
Polycarb lens |
5,204 |
4,367 |
$136K |
| V2110 |
Spherocylinder 4.25d/over 6d |
2,912 |
2,459 |
$128K |
| 92014 |
|
2,239 |
2,103 |
$102K |
| 92340 |
|
5,040 |
4,231 |
$99K |
| 92004 |
|
1,278 |
1,213 |
$79K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
1,199 |
1,033 |
$72K |
| V2210 |
Lens sphcy bifocal 4.25-7/ov |
678 |
590 |
$54K |
| 92341 |
|
1,486 |
1,317 |
$32K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
683 |
593 |
$31K |
| V2113 |
Spherocylindr 7.25d/4.25-6d |
62 |
53 |
$4K |
| V2209 |
Lens sphcy bifocal 4.25-7/4. |
37 |
32 |
$2K |
| V2212 |
Lens sphcyl bifo 7.25-12/2.2 |
14 |
14 |
$1K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
18 |
16 |
$676.94 |