| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
14,887 |
13,359 |
$475K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
8,151 |
7,065 |
$151K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,103 |
3,934 |
$74K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,537 |
3,165 |
$70K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,798 |
1,738 |
$61K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
528 |
480 |
$21K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
190 |
181 |
$16K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
219 |
218 |
$14K |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
138 |
135 |
$14K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
819 |
707 |
$13K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
811 |
703 |
$13K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
191 |
190 |
$12K |
| V2750 |
Anti-reflective coating, per lens |
1,270 |
1,227 |
$10K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
27 |
27 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
254 |
246 |
$2K |
| V2781 |
Progressive lens, per lens |
57 |
57 |
$2K |
| V2025 |
Deluxe frame |
395 |
394 |
$29.00 |
| V2799 |
Vision item or service, miscellaneous |
152 |
129 |
$15.20 |