| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
173 |
172 |
$13K |
| V2020 |
Frames, purchases |
451 |
442 |
$6K |
| 92004 |
|
89 |
89 |
$2K |
| 92340 |
|
58 |
57 |
$390.00 |
| 92342 |
|
27 |
25 |
$176.77 |
| V2025 |
Deluxe frame |
44 |
41 |
$162.50 |
| V2755 |
U-v lens, per lens |
75 |
73 |
$84.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
50 |
47 |
$21.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
66 |
66 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
27 |
27 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
18 |
18 |
$0.00 |