| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,869 |
2,867 |
$224K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,844 |
1,829 |
$30K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,409 |
1,398 |
$25K |
| V2750 |
Anti-reflective coating, per lens |
2,129 |
2,119 |
$11K |
| V2020 |
Frames, purchases |
627 |
613 |
$10K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
349 |
345 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$181.39 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$74.74 |
| V2799 |
Vision item or service, miscellaneous |
14 |
12 |
$35.00 |