| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
4,216 |
3,813 |
$76K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,165 |
2,828 |
$67K |
| V2750 |
Anti-reflective coating |
1,682 |
1,550 |
$49K |
| V2784 |
Lens polycarb or equal |
3,740 |
3,457 |
$31K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
857 |
743 |
$16K |
| V2100 |
Lens spher single plano 4.00 |
543 |
500 |
$12K |
| V2025 |
Eyeglasses delux frames |
472 |
384 |
$11K |
| V2107 |
Spherocylinder 4.25d/12-2d |
87 |
84 |
$2K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
45 |
44 |
$1K |
| V2744 |
Tint photochromatic lens/es |
12 |
12 |
$480.00 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
13 |
13 |
$302.83 |
| V2799 |
Misc vision item or service |
61 |
61 |
$0.00 |