| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,501 |
3,139 |
$54K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,316 |
2,035 |
$33K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,814 |
2,517 |
$23K |
| V2025 |
Deluxe frame |
672 |
538 |
$16K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
662 |
576 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
517 |
426 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
424 |
319 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
147 |
109 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
15 |
15 |
$446.28 |
| V2799 |
Vision item or service, miscellaneous |
278 |
268 |
$276.92 |