| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
|
19,754 |
19,691 |
$598K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
10,896 |
10,824 |
$248K |
| V2020 |
Vision svcs frames purchases |
21,373 |
21,282 |
$213K |
| V2100 |
Lens spher single plano 4.00 |
5,976 |
5,940 |
$136K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
4,761 |
4,739 |
$103K |
| V2107 |
Spherocylinder 4.25d/12-2d |
2,403 |
2,393 |
$51K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
153 |
151 |
$13K |
| V2101 |
Single visn sphere 4.12-7.00 |
445 |
441 |
$9K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
309 |
309 |
$6K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
293 |
291 |
$6K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
25 |
25 |
$502.20 |
| V2784 |
Lens polycarb or equal |
20,408 |
20,303 |
$360.09 |