| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
14,887 |
13,359 |
$475K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
8,151 |
7,065 |
$151K |
| V2784 |
Lens polycarb or equal |
4,103 |
3,934 |
$74K |
| V2100 |
Lens spher single plano 4.00 |
3,537 |
3,165 |
$70K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,798 |
1,738 |
$61K |
| V2200 |
Lens spher bifoc plano 4.00d |
528 |
480 |
$21K |
| V2520 |
Contact lens hydrophilic |
190 |
181 |
$16K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
219 |
218 |
$14K |
| V2521 |
Cntct lens hydrophilic toric |
138 |
135 |
$14K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
819 |
707 |
$13K |
| V2107 |
Spherocylinder 4.25d/12-2d |
811 |
703 |
$13K |
| V2410 |
Lens variab asphericity sing |
191 |
190 |
$12K |
| V2750 |
Anti-reflective coating |
1,270 |
1,227 |
$10K |
| V2523 |
Cntct lens hydrophil extend |
27 |
27 |
$3K |
| V2744 |
Tint photochromatic lens/es |
254 |
246 |
$2K |
| V2781 |
Progressive lens per lens |
57 |
57 |
$2K |
| V2025 |
Eyeglasses delux frames |
395 |
394 |
$29.00 |
| V2799 |
Misc vision item or service |
152 |
129 |
$15.20 |