| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
9,175 |
8,510 |
$458K |
| V2020 |
Frames, purchases |
10,856 |
9,558 |
$163K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,887 |
2,778 |
$128K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,395 |
3,358 |
$104K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
473 |
301 |
$23K |
| V2750 |
Anti-reflective coating, per lens |
101 |
96 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
44 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
47 |
42 |
$774.00 |