| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
42,334 |
40,896 |
$678K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
21,180 |
20,315 |
$361K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
2,761 |
2,699 |
$103K |
| V2100 |
Lens spher single plano 4.00 |
3,890 |
3,660 |
$65K |
| V2784 |
Lens polycarb or equal |
2,102 |
2,038 |
$28K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
549 |
518 |
$8K |
| V2200 |
Lens spher bifoc plano 4.00d |
144 |
130 |
$5K |
| V2750 |
Anti-reflective coating |
406 |
387 |
$4K |
| V2107 |
Spherocylinder 4.25d/12-2d |
170 |
147 |
$3K |
| V2523 |
Cntct lens hydrophil extend |
29 |
27 |
$1K |
| V2521 |
Cntct lens hydrophilic toric |
13 |
13 |
$650.00 |
| V2520 |
Contact lens hydrophilic |
12 |
12 |
$600.00 |
| V2025 |
Eyeglasses delux frames |
265 |
265 |
$290.00 |
| V2744 |
Tint photochromatic lens/es |
18 |
18 |
$193.80 |
| V2799 |
Misc vision item or service |
13 |
12 |
$0.00 |