| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,804 |
2,687 |
$65K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,249 |
1,176 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
567 |
503 |
$12K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
104 |
101 |
$4K |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
12 |
12 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
15 |
15 |
$315.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$162.64 |
| V2750 |
Anti-reflective coating, per lens |
39 |
39 |
$0.00 |
| V2025 |
Deluxe frame |
68 |
68 |
$0.00 |