| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,920 |
1,880 |
$58K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,255 |
1,223 |
$21K |
| V2750 |
Anti-reflective coating, per lens |
800 |
773 |
$7K |
| V2025 |
Deluxe frame |
79 |
78 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
165 |
160 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
145 |
145 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$60.00 |
| V2744 |
Tint, photochromatic, per lens |
25 |
25 |
$52.73 |
| V2799 |
Vision item or service, miscellaneous |
15 |
14 |
$41.82 |