| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,177 |
2,877 |
$64K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,310 |
1,206 |
$24K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
484 |
469 |
$11K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
134 |
121 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
38 |
37 |
$724.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$162.00 |
| V2799 |
Vision item or service, miscellaneous |
50 |
42 |
$60.00 |