| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Eyeglasses delux frames |
6,330 |
6,311 |
$445K |
| V2100 |
Lens spher single plano 4.00 |
3,489 |
3,472 |
$66K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,739 |
3,707 |
$63K |
| V2020 |
Vision svcs frames purchases |
2,687 |
2,622 |
$43K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,411 |
1,393 |
$20K |
| V2750 |
Anti-reflective coating |
2,850 |
2,831 |
$11K |
| V2799 |
Misc vision item or service |
1,260 |
1,158 |
$8K |
| V2744 |
Tint photochromatic lens/es |
737 |
735 |
$6K |
| V2784 |
Lens polycarb or equal |
642 |
634 |
$6K |
| V2107 |
Spherocylinder 4.25d/12-2d |
229 |
225 |
$4K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
69 |
68 |
$3K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
201 |
199 |
$3K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
16 |
15 |
$201.85 |