| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
3,602 |
3,601 |
$271K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,943 |
1,933 |
$35K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,124 |
2,103 |
$34K |
| V2020 |
Frames, purchases |
1,101 |
1,062 |
$18K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
548 |
539 |
$8K |
| V2750 |
Anti-reflective coating, per lens |
2,310 |
2,304 |
$7K |
| V2799 |
Vision item or service, miscellaneous |
884 |
830 |
$6K |
| V2744 |
Tint, photochromatic, per lens |
336 |
335 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
192 |
191 |
$2K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
97 |
97 |
$803.26 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
30 |
29 |
$400.43 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
12 |
12 |
$184.96 |