| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
9,969 |
9,405 |
$119K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,411 |
5,110 |
$49K |
| V2784 |
Lens polycarb or equal |
3,862 |
3,631 |
$34K |
| V2750 |
Anti-reflective coating |
1,228 |
1,210 |
$24K |
| V2781 |
Progressive lens per lens |
489 |
480 |
$16K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,497 |
1,430 |
$13K |
| V2100 |
Lens spher single plano 4.00 |
1,396 |
1,312 |
$10K |
| V2744 |
Tint photochromatic lens/es |
331 |
329 |
$8K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
892 |
851 |
$7K |
| V2520 |
Contact lens hydrophilic |
103 |
100 |
$5K |
| V2107 |
Spherocylinder 4.25d/12-2d |
632 |
597 |
$5K |
| V2521 |
Cntct lens hydrophilic toric |
69 |
69 |
$3K |
| V2025 |
Eyeglasses delux frames |
278 |
278 |
$3K |
| V2200 |
Lens spher bifoc plano 4.00d |
330 |
312 |
$2K |
| V2702 |
Deluxe lens feature |
172 |
167 |
$2K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
127 |
126 |
$949.97 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
108 |
99 |
$928.71 |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
45 |
45 |
$845.85 |
| V2799 |
Misc vision item or service |
374 |
362 |
$599.66 |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
75 |
73 |
$567.78 |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
55 |
53 |
$493.32 |
| V2523 |
Cntct lens hydrophil extend |
16 |
16 |
$452.44 |
| V2101 |
Single visn sphere 4.12-7.00 |
39 |
37 |
$247.49 |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
27 |
26 |
$211.81 |