| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,682 |
2,679 |
$164K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,207 |
2,197 |
$36K |
| V2750 |
Anti-reflective coating, per lens |
2,457 |
2,447 |
$23K |
| V2020 |
Frames, purchases |
792 |
784 |
$15K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
792 |
786 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
616 |
614 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
191 |
191 |
$2K |
| V2799 |
Vision item or service, miscellaneous |
300 |
282 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
14 |
14 |
$352.58 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
25 |
25 |
$343.30 |