| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
15,885 |
15,317 |
$252K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
7,862 |
7,614 |
$198K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,058 |
1,937 |
$127K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,866 |
2,781 |
$71K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
1,330 |
1,295 |
$37K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$757.46 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
14 |
$345.10 |