| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Eyeglasses delux frames |
3,220 |
3,219 |
$153K |
| 92340 |
|
6,001 |
5,925 |
$88K |
| 92014 |
|
1,464 |
1,435 |
$66K |
| 92004 |
|
1,062 |
1,032 |
$55K |
| V2020 |
Vision svcs frames purchases |
2,985 |
2,887 |
$39K |
| V2100 |
Lens spher single plano 4.00 |
1,560 |
1,447 |
$26K |
| 92015 |
|
1,316 |
1,275 |
$11K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,906 |
2,818 |
$2K |
| V2101 |
Single visn sphere 4.12-7.00 |
144 |
70 |
$790.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
12 |
12 |
$693.00 |
| V2784 |
Lens polycarb or equal |
2,670 |
2,600 |
$679.50 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
498 |
467 |
$400.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
320 |
301 |
$384.00 |
| V2702 |
Deluxe lens feature |
60 |
60 |
$36.00 |
| V2744 |
Tint photochromatic lens/es |
12 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating |
128 |
128 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
16 |
15 |
$0.00 |