| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,117 |
2,082 |
$60K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
889 |
883 |
$53K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,338 |
1,325 |
$49K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
587 |
584 |
$22K |
| V2755 |
U-v lens, per lens |
1,425 |
1,412 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
195 |
191 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$400.00 |