| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
20 |
20 |
$0.00 |
| V2020 |
Frames, purchases |
341 |
341 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
24 |
24 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
137 |
137 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
31 |
31 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
221 |
221 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
25 |
25 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$0.00 |