| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,227 |
6,027 |
$114K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,590 |
2,507 |
$52K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,945 |
1,873 |
$39K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
426 |
411 |
$18K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
309 |
297 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
125 |
114 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
104 |
98 |
$2K |
| V2025 |
Deluxe frame |
19 |
19 |
$0.00 |