| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,628 |
1,617 |
$128K |
| V2020 |
Frames, purchases |
2,464 |
2,105 |
$58K |
| 92004 |
|
1,156 |
1,101 |
$50K |
| 92014 |
|
1,183 |
1,150 |
$48K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,785 |
846 |
$20K |
| V2750 |
Anti-reflective coating, per lens |
281 |
175 |
$3K |
| 92015 |
|
602 |
558 |
$3K |
| 92012 |
|
43 |
43 |
$2K |
| 92340 |
|
141 |
141 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
14 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
24 |
$889.50 |
| V2760 |
Scratch resistant coating, per lens |
151 |
104 |
$540.00 |
| V2025 |
Deluxe frame |
31 |
31 |
$368.28 |