| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,621 |
2,548 |
$120K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,367 |
1,331 |
$71K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
558 |
554 |
$27K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
541 |
508 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
58 |
57 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
58 |
58 |
$1K |