| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
3,398 |
3,393 |
$224K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,149 |
2,135 |
$40K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,235 |
2,212 |
$37K |
| V2020 |
Frames, purchases |
1,512 |
1,484 |
$23K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
507 |
497 |
$7K |
| V2750 |
Anti-reflective coating, per lens |
1,471 |
1,459 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
118 |
117 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
102 |
102 |
$693.73 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
36 |
36 |
$577.23 |
| V2799 |
Vision item or service, miscellaneous |
20 |
13 |
$60.00 |