| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,292 |
3,067 |
$111K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,967 |
1,857 |
$39K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
477 |
439 |
$8K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
18 |
14 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$990.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
42 |
42 |
$773.25 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
241 |
238 |
$666.00 |
| V2750 |
Anti-reflective coating, per lens |
682 |
666 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
29 |
29 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
15 |
14 |
$0.00 |