| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,296 |
3,190 |
$133K |
| V2020 |
Frames, purchases |
5,061 |
4,858 |
$132K |
| V2025 |
Deluxe frame |
2,222 |
2,190 |
$131K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,625 |
2,533 |
$110K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
881 |
856 |
$36K |
| V2760 |
Scratch resistant coating, per lens |
1,532 |
1,494 |
$20K |
| V2755 |
U-v lens, per lens |
821 |
805 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
427 |
417 |
$17K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
67 |
65 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
73 |
69 |
$3K |