| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens polycarb or equal |
16,279 |
14,925 |
$758K |
| V2020 |
Vision svcs frames purchases |
19,671 |
19,056 |
$721K |
| 92014 |
|
7,735 |
7,352 |
$502K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
12,267 |
11,402 |
$421K |
| 92004 |
|
4,214 |
4,095 |
$335K |
| V2744 |
Tint photochromatic lens/es |
4,565 |
4,493 |
$130K |
| 92015 |
|
17,326 |
16,318 |
$82K |
| V2100 |
Lens spher single plano 4.00 |
1,731 |
1,647 |
$47K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
957 |
919 |
$40K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,170 |
668 |
$32K |
| V2107 |
Spherocylinder 4.25d/12-2d |
295 |
277 |
$13K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
166 |
97 |
$8K |
| 92250 |
|
405 |
400 |
$6K |
| V2781 |
Progressive lens per lens |
167 |
87 |
$4K |
| 99214 |
|
49 |
37 |
$1K |