| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,730 |
2,640 |
$69K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
919 |
866 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,116 |
1,069 |
$22K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
835 |
801 |
$11K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
38 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
29 |
29 |
$1K |
| V2781 |
Progressive lens, per lens |
18 |
18 |
$333.50 |
| V2025 |
Deluxe frame |
110 |
110 |
$278.00 |
| V2750 |
Anti-reflective coating, per lens |
83 |
81 |
$0.00 |