| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,455 |
2,453 |
$172K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,067 |
2,058 |
$35K |
| V2020 |
Frames, purchases |
876 |
862 |
$21K |
| V2750 |
Anti-reflective coating, per lens |
1,397 |
1,395 |
$13K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
789 |
783 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
314 |
313 |
$5K |
| V2744 |
Tint, photochromatic, per lens |
195 |
195 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
266 |
266 |
$3K |
| V2799 |
Vision item or service, miscellaneous |
224 |
178 |
$1K |