| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,637 |
2,633 |
$190K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,530 |
1,511 |
$28K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,435 |
1,413 |
$23K |
| V2020 |
Frames, purchases |
1,006 |
964 |
$17K |
| V2750 |
Anti-reflective coating, per lens |
1,938 |
1,926 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
325 |
320 |
$5K |
| V2799 |
Vision item or service, miscellaneous |
616 |
392 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
193 |
193 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
61 |
60 |
$852.56 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
66 |
66 |
$552.80 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
12 |
12 |
$136.85 |