| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
645,581 |
623,186 |
$7.04M |
| V2784 |
Lens polycarb or equal |
552,358 |
395,900 |
$4.39M |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
330,898 |
248,897 |
$2.50M |
| V2100 |
Lens spher single plano 4.00 |
300,922 |
264,087 |
$2.19M |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
90,455 |
69,330 |
$950K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
3,360 |
3,300 |
$386K |
| S0580 |
Polycarb lens |
23,227 |
22,871 |
$371K |
| V2200 |
Lens spher bifoc plano 4.00d |
34,799 |
29,825 |
$301K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
41,105 |
30,178 |
$297K |
| V2799 |
Misc vision item or service |
2,754 |
2,589 |
$212K |
| V2410 |
Lens variab asphericity sing |
3,232 |
3,181 |
$191K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
3,993 |
3,925 |
$183K |
| V2760 |
Scratch resistant coating |
15,783 |
15,576 |
$153K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
27,450 |
20,345 |
$152K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
19,092 |
17,098 |
$131K |
| V2107 |
Spherocylinder 4.25d/12-2d |
15,936 |
14,707 |
$123K |
| V2113 |
Spherocylindr 7.25d/4.25-6d |
9,090 |
6,808 |
$97K |
| V2756 |
Eye glass case |
175,048 |
171,821 |
$86K |
| V2101 |
Single visn sphere 4.12-7.00 |
11,343 |
9,344 |
$76K |
| V2205 |
Lens sphcy bifocal 4.00d/4.2 |
7,572 |
5,793 |
$59K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
2,845 |
2,760 |
$33K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
2,212 |
2,129 |
$30K |
| V2745 |
Tint, any color/solid/grad |
3,267 |
3,228 |
$28K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
3,975 |
3,626 |
$26K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
901 |
878 |
$20K |
| V2715 |
Prism lens/es |
3,652 |
3,596 |
$18K |
| V2114 |
Spherocylinder over 12.00d |
1,085 |
860 |
$13K |
| V2102 |
Singl visn sphere 7.12-20.00 |
1,706 |
1,404 |
$13K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
1,049 |
980 |
$12K |
| V2730 |
Special base curve |
764 |
744 |
$11K |
| V2744 |
Tint photochromatic lens/es |
1,012 |
912 |
$10K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
911 |
844 |
$9K |
| V2201 |
Lens sphere bifocal 4.12-7.0 |
977 |
878 |
$8K |
| V2211 |
Lens sphcy bifo 7.25-12/.25- |
453 |
428 |
$8K |
| V2430 |
Lens variable asphericity bi |
77 |
77 |
$6K |
| V2300 |
Lens sphere trifocal 4.00d |
365 |
277 |
$6K |
| V2208 |
Lens sphcy bifocal 4.25-7/2. |
502 |
483 |
$6K |
| V2219 |
Lens bifocal seg width over |
217 |
212 |
$4K |
| V2106 |
Spherocylinder 4.00d/>6.00d |
512 |
434 |
$4K |
| V2220 |
Lens bifocal add over 3.25d |
488 |
477 |
$3K |
| V2215 |
Lens lenticular bifocal |
32 |
28 |
$2K |
| V2202 |
Lens sphere bifocal 7.12-20. |
79 |
63 |
$961.65 |
| V2212 |
Lens sphcyl bifo 7.25-12/2.2 |
31 |
29 |
$457.65 |
| V2199 |
Lens single vision not oth c |
39 |
39 |
$255.00 |
| V2700 |
Balance lens |
302 |
299 |
$162.00 |
| V2299 |
Lens bifocal speciality |
12 |
12 |
$160.00 |
| V2750 |
Anti-reflective coating |
14 |
14 |
$16.00 |