| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
3,255 |
3,251 |
$301K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,038 |
3,027 |
$51K |
| V2020 |
Frames, purchases |
1,391 |
1,367 |
$21K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
251 |
249 |
$12K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
745 |
741 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
329 |
323 |
$5K |
| V2799 |
Vision item or service, miscellaneous |
440 |
411 |
$4K |
| V2750 |
Anti-reflective coating, per lens |
971 |
968 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$210.00 |