| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
11,717 |
11,171 |
$338K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
7,174 |
6,855 |
$149K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,418 |
2,396 |
$94K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,640 |
4,588 |
$73K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,113 |
2,025 |
$40K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,321 |
1,241 |
$24K |
| V2025 |
Deluxe frame |
2,052 |
2,052 |
$19K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
813 |
777 |
$16K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
353 |
346 |
$14K |
| V2750 |
Anti-reflective coating, per lens |
2,180 |
2,129 |
$11K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
94 |
94 |
$5K |
| V2744 |
Tint, photochromatic, per lens |
843 |
834 |
$3K |
| V2430 |
Variable asphericity lens, bifocal, full field, glass or plastic, per lens |
14 |
13 |
$1K |
| V2781 |
Progressive lens, per lens |
28 |
28 |
$750.00 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
12 |
12 |
$232.00 |
| V2799 |
Vision item or service, miscellaneous |
188 |
177 |
$22.00 |