| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
4,017 |
4,016 |
$319K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,100 |
3,094 |
$52K |
| V2020 |
Frames, purchases |
932 |
926 |
$17K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,098 |
1,097 |
$16K |
| V2750 |
Anti-reflective coating, per lens |
1,678 |
1,678 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
571 |
568 |
$8K |
| V2744 |
Tint, photochromatic, per lens |
249 |
249 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
248 |
248 |
$3K |
| V2799 |
Vision item or service, miscellaneous |
274 |
267 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
79 |
79 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
43 |
42 |
$550.40 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$194.09 |