| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,805 |
1,803 |
$136K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
899 |
899 |
$54K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
369 |
368 |
$27K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
63 |
63 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
72 |
72 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
135 |
135 |
$4K |
| V2025 |
Deluxe frame |
17 |
17 |
$850.00 |