| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
5,602 |
5,361 |
$78K |
| V2100 |
Lens spher single plano 4.00 |
3,081 |
2,848 |
$51K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,179 |
3,092 |
$46K |
| V2025 |
Eyeglasses delux frames |
2,456 |
2,370 |
$41K |
| V2784 |
Lens polycarb or equal |
5,226 |
4,947 |
$37K |
| 92340 |
|
1,321 |
1,294 |
$34K |
| V2200 |
Lens spher bifoc plano 4.00d |
345 |
321 |
$9K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
428 |
420 |
$9K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
569 |
545 |
$8K |
| V2107 |
Spherocylinder 4.25d/12-2d |
110 |
110 |
$1K |
| 92341 |
|
52 |
52 |
$1K |
| V2781 |
Progressive lens per lens |
42 |
41 |
$90.00 |
| V2799 |
Misc vision item or service |
494 |
474 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
12 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating |
1,996 |
1,890 |
$0.00 |
| V2745 |
Tint, any color/solid/grad |
313 |
308 |
$0.00 |
| V2199 |
Lens single vision not oth c |
22 |
22 |
$0.00 |