| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Eyeglasses delux frames |
5,416 |
4,989 |
$394K |
| V2219 |
Lens bifocal seg width over |
3,612 |
3,348 |
$314K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
2,905 |
2,699 |
$262K |
| V2784 |
Lens polycarb or equal |
3,618 |
3,336 |
$240K |
| V2760 |
Scratch resistant coating |
5,152 |
4,746 |
$156K |
| 92341 |
|
4,546 |
4,379 |
$148K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
1,204 |
1,120 |
$138K |
| 92004 |
|
908 |
883 |
$121K |
| V2799 |
Misc vision item or service |
309 |
292 |
$84K |
| V2200 |
Lens spher bifoc plano 4.00d |
991 |
896 |
$69K |
| 92340 |
|
2,372 |
2,289 |
$64K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
690 |
617 |
$38K |
| V2215 |
Lens lenticular bifocal |
190 |
189 |
$32K |
| V2780 |
Oversize lens/es |
915 |
858 |
$17K |
| V2020 |
Vision svcs frames purchases |
267 |
262 |
$15K |
| 92015 |
|
600 |
578 |
$14K |
| V2781 |
Progressive lens per lens |
72 |
72 |
$10K |
| V2100 |
Lens spher single plano 4.00 |
163 |
149 |
$8K |
| 92014 |
|
45 |
40 |
$4K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
30 |
30 |
$4K |
| V2744 |
Tint photochromatic lens/es |
153 |
146 |
$4K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
35 |
34 |
$4K |
| 92370 |
|
60 |
60 |
$2K |
| G0117 |
Glaucoma scrn hgh risk direc |
13 |
12 |
$696.36 |