| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,317 |
1,301 |
$85K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
812 |
794 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
680 |
660 |
$11K |
| V2020 |
Frames, purchases |
383 |
356 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
1,193 |
1,168 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
45 |
45 |
$679.44 |
| V2799 |
Vision item or service, miscellaneous |
15 |
14 |
$105.09 |
| V2744 |
Tint, photochromatic, per lens |
13 |
13 |
$63.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$41.58 |