| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
8,401 |
7,995 |
$203K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,137 |
4,865 |
$109K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,974 |
2,869 |
$62K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,713 |
3,670 |
$45K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,032 |
1,027 |
$41K |
| V2025 |
Deluxe frame |
2,033 |
2,033 |
$18K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
386 |
376 |
$14K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
115 |
109 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
423 |
407 |
$8K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
312 |
309 |
$7K |
| V2750 |
Anti-reflective coating, per lens |
1,745 |
1,725 |
$4K |
| V2781 |
Progressive lens, per lens |
65 |
65 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
334 |
333 |
$1K |
| V2799 |
Vision item or service, miscellaneous |
77 |
60 |
$0.00 |