| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,333 |
2,221 |
$41K |
| V2020 |
Frames, purchases |
4,165 |
3,864 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
446 |
418 |
$7K |
| V2750 |
Anti-reflective coating, per lens |
1,484 |
1,369 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
633 |
546 |
$901.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
24 |
24 |
$399.08 |
| V2744 |
Tint, photochromatic, per lens |
477 |
455 |
$165.00 |
| V2781 |
Progressive lens, per lens |
228 |
197 |
$43.50 |