| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,811 |
3,764 |
$91K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,146 |
2,119 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
319 |
315 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
129 |
128 |
$5K |
| V2781 |
Progressive lens, per lens |
41 |
41 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
53 |
53 |
$971.52 |
| V2750 |
Anti-reflective coating, per lens |
39 |
38 |
$246.00 |
| 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 |
$225.00 |