| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,880 |
6,581 |
$154K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
7,954 |
7,688 |
$97K |
| V2020 |
Frames, purchases |
8,539 |
8,234 |
$96K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
495 |
493 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
169 |
168 |
$2K |
| V2300 |
Sphere, trifocal, plano to plus or minus 4.00d, per lens |
16 |
15 |
$93.00 |
| V2781 |
Progressive lens, per lens |
25 |
25 |
$0.00 |