| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
6,085 |
6,069 |
$404K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,205 |
5,162 |
$90K |
| V2020 |
Frames, purchases |
3,098 |
3,063 |
$49K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,314 |
2,303 |
$42K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,383 |
1,371 |
$20K |
| V2750 |
Anti-reflective coating, per lens |
2,301 |
2,289 |
$10K |
| V2744 |
Tint, photochromatic, per lens |
652 |
648 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
613 |
610 |
$4K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
261 |
260 |
$4K |
| V2799 |
Vision item or service, miscellaneous |
530 |
502 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
78 |
78 |
$986.95 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
50 |
47 |
$557.94 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
16 |
$539.00 |