| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
556 |
540 |
$46K |
| V2781 |
Progressive lens, per lens |
343 |
336 |
$21K |
| V2750 |
Anti-reflective coating, per lens |
563 |
545 |
$12K |
| V2744 |
Tint, photochromatic, per lens |
407 |
400 |
$5K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
245 |
242 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
93 |
91 |
$2K |
| V2762 |
Polarization, any lens material, per lens |
186 |
182 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
13 |
$429.90 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
46 |
46 |
$307.20 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
33 |
32 |
$0.00 |