| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
2,834 |
2,809 |
$42K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,514 |
1,503 |
$33K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
432 |
431 |
$21K |
| V2100 |
Lens spher single plano 4.00 |
646 |
639 |
$12K |
| V2781 |
Progressive lens per lens |
56 |
50 |
$4K |
| V2200 |
Lens spher bifoc plano 4.00d |
90 |
90 |
$3K |
| V2107 |
Spherocylinder 4.25d/12-2d |
162 |
158 |
$3K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
189 |
187 |
$3K |
| V2784 |
Lens polycarb or equal |
334 |
321 |
$1K |
| V2744 |
Tint photochromatic lens/es |
101 |
94 |
$163.40 |
| S0620 |
Routine ophthalmological exa |
141 |
141 |
$150.00 |
| V2799 |
Misc vision item or service |
84 |
71 |
$0.00 |
| V2755 |
Uv lens/es |
87 |
86 |
$0.00 |
| V2750 |
Anti-reflective coating |
516 |
501 |
$0.00 |