| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17,413 |
11,215 |
$917K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
7,735 |
4,545 |
$196K |
| V2020 |
Frames, purchases |
17,356 |
11,317 |
$151K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,366 |
4,014 |
$146K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,333 |
796 |
$45K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,248 |
984 |
$38K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
1,215 |
669 |
$35K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
939 |
685 |
$25K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
654 |
498 |
$15K |
| V2750 |
Anti-reflective coating, per lens |
162 |
144 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
138 |
124 |
$450.00 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
15 |
12 |
$342.00 |
| V2781 |
Progressive lens, per lens |
193 |
160 |
$227.60 |
| V2025 |
Deluxe frame |
62 |
29 |
$0.00 |