| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,834 |
2,809 |
$42K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,514 |
1,503 |
$33K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
432 |
431 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
646 |
639 |
$12K |
| V2781 |
Progressive lens, per lens |
56 |
50 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
90 |
90 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
162 |
158 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
189 |
187 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
334 |
321 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
101 |
94 |
$163.40 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
141 |
141 |
$150.00 |
| V2799 |
Vision item or service, miscellaneous |
84 |
71 |
$0.00 |
| V2755 |
U-v lens, per lens |
87 |
86 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
516 |
501 |
$0.00 |