| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
5,180 |
4,927 |
$114K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,735 |
2,569 |
$51K |
| V2100 |
Lens spher single plano 4.00 |
1,698 |
1,598 |
$36K |
| V2784 |
Lens polycarb or equal |
1,885 |
1,826 |
$24K |
| V2744 |
Tint photochromatic lens/es |
303 |
303 |
$8K |
| V2750 |
Anti-reflective coating |
654 |
637 |
$7K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
128 |
127 |
$5K |
| V2200 |
Lens spher bifoc plano 4.00d |
98 |
92 |
$4K |
| V2521 |
Cntct lens hydrophilic toric |
26 |
26 |
$3K |
| V2523 |
Cntct lens hydrophil extend |
13 |
13 |
$2K |
| V2025 |
Eyeglasses delux frames |
501 |
501 |
$2K |
| V2520 |
Contact lens hydrophilic |
12 |
12 |
$2K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
77 |
74 |
$1K |
| V2755 |
Uv lens/es |
107 |
107 |
$856.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
25 |
25 |
$300.16 |