| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
1,222 |
1,216 |
$26.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
1,685 |
1,066 |
$0.00 |
| V2020 |
Vision svcs frames purchases |
22,888 |
22,729 |
$0.00 |
| 92014 |
|
14,199 |
14,072 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
4,466 |
2,475 |
$0.00 |
| V2750 |
Anti-reflective coating |
4,595 |
2,323 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
25,643 |
14,404 |
$0.00 |
| S0500 |
Dispos cont lens |
1,636 |
1,630 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
4,565 |
2,329 |
$0.00 |
| V2100 |
Lens spher single plano 4.00 |
2,978 |
2,139 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
3,211 |
2,216 |
$0.00 |
| 92310 |
|
1,594 |
1,574 |
$0.00 |
| 92002 |
|
6,936 |
6,928 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
87 |
66 |
$0.00 |
| V2799 |
Misc vision item or service |
310 |
153 |
$0.00 |
| V2781 |
Progressive lens per lens |
139 |
77 |
$0.00 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
37 |
26 |
$0.00 |
| S0581 |
Nonstnd lens |
123 |
62 |
$0.00 |