| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,424 |
4,097 |
$120K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,524 |
2,278 |
$47K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,561 |
1,543 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,028 |
964 |
$20K |
| V2750 |
Anti-reflective coating, per lens |
1,494 |
1,451 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
160 |
159 |
$6K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
26 |
26 |
$1K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
13 |
12 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
43 |
41 |
$1K |
| V2025 |
Deluxe frame |
120 |
120 |
$1K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
13 |
13 |
$873.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
14 |
13 |
$307.00 |
| V2744 |
Tint, photochromatic, per lens |
19 |
19 |
$204.00 |