| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,169 |
2,148 |
$66K |
| V2020 |
Frames, purchases |
2,120 |
2,040 |
$61K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,480 |
1,439 |
$34K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,666 |
1,655 |
$23K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,249 |
1,237 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
141 |
138 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
105 |
105 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
50 |
49 |
$0.00 |