| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,554 |
4,321 |
$98K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,151 |
2,012 |
$41K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,225 |
1,142 |
$26K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,067 |
1,025 |
$14K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
235 |
232 |
$10K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
86 |
83 |
$9K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
128 |
112 |
$4K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
13 |
13 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$299.82 |
| V2025 |
Deluxe frame |
134 |
134 |
$120.00 |
| V2750 |
Anti-reflective coating, per lens |
108 |
100 |
$0.00 |