| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,515 |
3,543 |
$320K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,457 |
1,351 |
$86K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,613 |
1,358 |
$54K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,584 |
1,240 |
$45K |
| V2025 |
Deluxe frame |
336 |
321 |
$15K |
| V2744 |
Tint, photochromatic, per lens |
25 |
25 |
$626.54 |
| V2750 |
Anti-reflective coating, per lens |
15 |
14 |
$77.76 |
| V2799 |
Vision item or service, miscellaneous |
32 |
32 |
$0.00 |