| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,968 |
2,924 |
$61K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,134 |
2,105 |
$37K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
572 |
570 |
$9K |
| V2750 |
Anti-reflective coating, per lens |
1,769 |
1,747 |
$9K |
| V2025 |
Deluxe frame |
149 |
149 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
253 |
249 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
169 |
168 |
$760.66 |
| V2744 |
Tint, photochromatic, per lens |
56 |
56 |
$315.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$199.50 |
| V2799 |
Vision item or service, miscellaneous |
207 |
189 |
$150.41 |