| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
3,846 |
3,830 |
$268K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,674 |
2,642 |
$42K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,939 |
1,930 |
$35K |
| V2020 |
Frames, purchases |
1,601 |
1,564 |
$25K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
808 |
798 |
$11K |
| V2750 |
Anti-reflective coating, per lens |
2,536 |
2,517 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
369 |
363 |
$3K |
| V2799 |
Vision item or service, miscellaneous |
414 |
400 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
332 |
330 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$331.02 |