| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,586 |
2,875 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
982 |
534 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,890 |
3,163 |
$0.00 |
| V2755 |
U-v lens, per lens |
1,984 |
1,059 |
$0.00 |
| V2781 |
Progressive lens, per lens |
460 |
272 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
381 |
234 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
83 |
41 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
147 |
77 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
22 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
4,952 |
2,568 |
$0.00 |
| V2020 |
Frames, purchases |
5,806 |
5,540 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
3,937 |
1,983 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
227 |
126 |
$0.00 |