| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
200 |
190 |
$13K |
| 92004 |
|
88 |
84 |
$8K |
| 92340 |
|
228 |
220 |
$7K |
| V2020 |
Frames, purchases |
230 |
222 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
174 |
168 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
129 |
122 |
$976.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
14 |
$280.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$260.00 |
| V2760 |
Scratch resistant coating, per lens |
129 |
122 |
$244.00 |