| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
7,334 |
7,091 |
$114K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,576 |
5,144 |
$111K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,824 |
4,665 |
$110K |
| V2750 |
Anti-reflective coating, per lens |
3,635 |
3,514 |
$91K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
808 |
760 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
138 |
127 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
74 |
69 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
29 |
26 |
$851.36 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
13 |
12 |
$425.37 |