| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,105 |
4,074 |
$80K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,516 |
2,501 |
$48K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
985 |
975 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
598 |
592 |
$10K |
| V2750 |
Anti-reflective coating, per lens |
2,120 |
2,111 |
$6K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
155 |
153 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
372 |
372 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
74 |
72 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
112 |
112 |
$877.09 |
| V2799 |
Vision item or service, miscellaneous |
47 |
46 |
$0.00 |