| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,128 |
1,648 |
$63K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
976 |
953 |
$27K |
| V2025 |
Deluxe frame |
467 |
463 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
483 |
476 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
149 |
149 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
94 |
93 |
$3K |