| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
9,969 |
9,405 |
$119K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,411 |
5,110 |
$49K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,862 |
3,631 |
$34K |
| V2750 |
Anti-reflective coating, per lens |
1,228 |
1,210 |
$24K |
| V2781 |
Progressive lens, per lens |
489 |
480 |
$16K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,497 |
1,430 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,396 |
1,312 |
$10K |
| V2744 |
Tint, photochromatic, per lens |
331 |
329 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
892 |
851 |
$7K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
103 |
100 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
632 |
597 |
$5K |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
69 |
69 |
$3K |
| V2025 |
Deluxe frame |
278 |
278 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
330 |
312 |
$2K |
| V2702 |
Deluxe lens feature |
172 |
167 |
$2K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
127 |
126 |
$949.97 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
108 |
99 |
$928.71 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
45 |
45 |
$845.85 |
| V2799 |
Vision item or service, miscellaneous |
374 |
362 |
$599.66 |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
75 |
73 |
$567.78 |
| V2111 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens |
55 |
53 |
$493.32 |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
16 |
16 |
$452.44 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
39 |
37 |
$247.49 |
| V2207 |
Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens |
27 |
26 |
$211.81 |