| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Lens spher single plano 4.00 |
7,316 |
3,286 |
$267K |
| V2020 |
Vision svcs frames purchases |
5,913 |
4,870 |
$200K |
| 92014 |
|
3,751 |
3,706 |
$151K |
| V2744 |
Tint photochromatic lens/es |
3,481 |
2,039 |
$86K |
| 92004 |
|
1,962 |
1,934 |
$82K |
| V2299 |
Lens bifocal speciality |
1,712 |
949 |
$72K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,132 |
808 |
$62K |
| 92012 |
|
1,216 |
1,198 |
$43K |
| V2781 |
Progressive lens per lens |
2,094 |
1,265 |
$41K |
| V2750 |
Anti-reflective coating |
2,751 |
1,547 |
$38K |
| 92250 |
|
593 |
585 |
$24K |
| V2760 |
Scratch resistant coating |
2,444 |
1,318 |
$20K |
| 92133 |
|
290 |
282 |
$6K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
206 |
74 |
$6K |
| V2784 |
Lens polycarb or equal |
800 |
328 |
$5K |
| V2025 |
Eyeglasses delux frames |
238 |
236 |
$3K |
| 92020 |
|
247 |
240 |
$2K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
56 |
28 |
$2K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
49 |
25 |
$1K |
| 76514 |
|
204 |
198 |
$1K |