| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
4,895 |
4,745 |
$92K |
| V2784 |
Lens polycarb or equal |
2,768 |
2,668 |
$66K |
| V2750 |
Anti-reflective coating |
1,901 |
1,837 |
$49K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,713 |
2,199 |
$43K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
456 |
323 |
$15K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
849 |
680 |
$12K |
| V2100 |
Lens spher single plano 4.00 |
440 |
406 |
$7K |
| V2107 |
Spherocylinder 4.25d/12-2d |
259 |
238 |
$4K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
32 |
32 |
$2K |
| V2200 |
Lens spher bifoc plano 4.00d |
13 |
12 |
$608.40 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
43 |
39 |
$560.29 |