| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,305 |
3,162 |
$80K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,138 |
2,066 |
$46K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,910 |
2,836 |
$45K |
| V2025 |
Deluxe frame |
962 |
957 |
$29K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
449 |
435 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
97 |
94 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
167 |
163 |
$610.08 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
39 |
39 |
$422.24 |