| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,809 |
3,766 |
$121K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,069 |
2,045 |
$34K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,229 |
1,213 |
$18K |
| V2750 |
Anti-reflective coating, per lens |
2,654 |
2,630 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
194 |
192 |
$3K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
188 |
187 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
528 |
528 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
55 |
55 |
$767.00 |
| V2025 |
Deluxe frame |
14 |
14 |
$618.54 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$143.00 |
| V2799 |
Vision item or service, miscellaneous |
283 |
209 |
$122.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
39 |
38 |
$82.00 |