| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,533 |
1,658 |
$95K |
| V2020 |
Frames, purchases |
3,562 |
2,711 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,096 |
2,052 |
$43K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
729 |
609 |
$11K |
| V2755 |
U-v lens, per lens |
263 |
257 |
$8K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
425 |
423 |
$6K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
56 |
55 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
54 |
53 |
$0.00 |