| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,783 |
4,525 |
$84K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,009 |
2,945 |
$58K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
974 |
941 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
500 |
488 |
$8K |
| V2750 |
Anti-reflective coating, per lens |
1,916 |
1,876 |
$4K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
127 |
127 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
94 |
92 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
133 |
127 |
$313.61 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
74 |
71 |
$264.00 |
| V2799 |
Vision item or service, miscellaneous |
502 |
439 |
$54.75 |