| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,986 |
6,249 |
$95K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,927 |
3,494 |
$70K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,985 |
1,848 |
$39K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
361 |
333 |
$13K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
124 |
117 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
60 |
55 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
55 |
55 |
$653.60 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$159.98 |
| V2781 |
Progressive lens, per lens |
96 |
96 |
$0.00 |