| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,918 |
2,798 |
$84K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,423 |
1,380 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
934 |
928 |
$15K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
243 |
242 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
313 |
302 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
284 |
279 |
$3K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
24 |
24 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
60 |
60 |
$1K |
| V2755 |
U-v lens, per lens |
134 |
132 |
$1K |
| V2025 |
Deluxe frame |
76 |
76 |
$750.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$460.00 |