| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
608 |
608 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
413 |
413 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
260 |
260 |
$5K |
| 92341 |
|
141 |
141 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
121 |
121 |
$4K |
| 92340 |
|
151 |
151 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
72 |
72 |
$3K |
| V2760 |
Scratch resistant coating, per lens |
220 |
220 |
$3K |
| V2755 |
U-v lens, per lens |
93 |
93 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
46 |
46 |
$895.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
46 |
46 |
$848.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
33 |
33 |
$597.00 |