| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
71,376 |
65,909 |
$516K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
38,781 |
35,655 |
$354K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
11,181 |
10,589 |
$150K |
| V2100 |
Lens spher single plano 4.00 |
16,847 |
15,386 |
$137K |
| V2107 |
Spherocylinder 4.25d/12-2d |
5,488 |
5,060 |
$45K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
5,718 |
5,211 |
$44K |
| V2025 |
Eyeglasses delux frames |
1,030 |
678 |
$32K |
| V2200 |
Lens spher bifoc plano 4.00d |
2,745 |
2,612 |
$28K |
| V2715 |
Prism lens/es |
781 |
448 |
$17K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
1,326 |
1,250 |
$13K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
649 |
618 |
$13K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
941 |
889 |
$11K |
| V2101 |
Single visn sphere 4.12-7.00 |
1,421 |
1,297 |
$10K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
1,265 |
1,159 |
$9K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
869 |
799 |
$7K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
933 |
828 |
$7K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
205 |
180 |
$1K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
145 |
131 |
$1K |
| V2201 |
Lens sphere bifocal 4.12-7.0 |
50 |
48 |
$453.03 |
| V2102 |
Singl visn sphere 7.12-20.00 |
44 |
42 |
$350.88 |
| V2208 |
Lens sphcy bifocal 4.25-7/2. |
30 |
29 |
$277.78 |
| V2300 |
Lens sphere trifocal 4.00d |
12 |
12 |
$192.27 |
| V2205 |
Lens sphcy bifocal 4.00d/4.2 |
13 |
12 |
$114.38 |