| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
5,292 |
4,794 |
$211K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,451 |
2,165 |
$46K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
515 |
514 |
$35K |
| V2100 |
Lens spher single plano 4.00 |
1,151 |
1,002 |
$21K |
| V2410 |
Lens variab asphericity sing |
289 |
289 |
$18K |
| V2784 |
Lens polycarb or equal |
827 |
818 |
$18K |
| V2750 |
Anti-reflective coating |
1,302 |
1,238 |
$15K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
424 |
421 |
$15K |
| V2521 |
Cntct lens hydrophilic toric |
16 |
16 |
$1K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
68 |
47 |
$1K |
| V2107 |
Spherocylinder 4.25d/12-2d |
40 |
36 |
$745.50 |
| V2200 |
Lens spher bifoc plano 4.00d |
16 |
15 |
$595.00 |
| V2781 |
Progressive lens per lens |
12 |
12 |
$237.00 |