| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,977 |
6,736 |
$101K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,249 |
4,137 |
$92K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
977 |
945 |
$62K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
429 |
393 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
921 |
898 |
$15K |
| V2025 |
Deluxe frame |
284 |
283 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
516 |
507 |
$9K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
433 |
417 |
$8K |