| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
20,262 |
18,603 |
$537K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
16,537 |
10,003 |
$456K |
| V2755 |
Uv lens/es |
20,980 |
11,703 |
$223K |
| V2100 |
Lens spher single plano 4.00 |
7,735 |
4,688 |
$211K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
7,128 |
4,618 |
$202K |
| V2107 |
Spherocylinder 4.25d/12-2d |
3,457 |
2,163 |
$112K |
| V2784 |
Lens polycarb or equal |
7,670 |
7,083 |
$89K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
1,155 |
854 |
$46K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
936 |
637 |
$32K |
| V2101 |
Single visn sphere 4.12-7.00 |
713 |
456 |
$22K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
196 |
172 |
$14K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
228 |
148 |
$11K |
| 92004 |
|
72 |
70 |
$7K |
| 92015 |
|
342 |
333 |
$5K |
| 92014 |
|
51 |
49 |
$4K |
| V2114 |
Spherocylinder over 12.00d |
35 |
25 |
$3K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
34 |
25 |
$2K |