| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,639 |
4,120 |
$100K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,516 |
2,956 |
$67K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,135 |
3,467 |
$35K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
502 |
361 |
$8K |
| V2025 |
Deluxe frame |
184 |
138 |
$6K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
332 |
259 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
212 |
160 |
$3K |
| V2756 |
Eye glass case |
837 |
665 |
$627.46 |