| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,487 |
5,391 |
$170K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,402 |
3,344 |
$56K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,272 |
1,246 |
$18K |
| V2750 |
Anti-reflective coating, per lens |
2,201 |
2,162 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,101 |
1,087 |
$17K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
155 |
151 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
64 |
62 |
$834.00 |
| V2744 |
Tint, photochromatic, per lens |
188 |
186 |
$380.00 |
| V2799 |
Vision item or service, miscellaneous |
514 |
451 |
$261.42 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
41 |
41 |
$24.00 |