| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
505 |
447 |
$87K |
| 92004 |
|
639 |
595 |
$50K |
| V2025 |
Eyeglasses delux frames |
672 |
616 |
$43K |
| 92014 |
|
432 |
412 |
$30K |
| 99211 |
|
2,002 |
1,837 |
$25K |
| V2020 |
Vision svcs frames purchases |
1,249 |
1,139 |
$19K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,060 |
956 |
$18K |
| V2760 |
Scratch resistant coating |
1,166 |
1,019 |
$18K |
| V2745 |
Tint, any color/solid/grad |
1,167 |
1,019 |
$9K |
| V2100 |
Lens spher single plano 4.00 |
425 |
395 |
$8K |
| V2107 |
Spherocylinder 4.25d/12-2d |
13 |
13 |
$287.82 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
14 |
14 |
$273.60 |