| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
13,772 |
11,423 |
$396K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
7,753 |
6,150 |
$163K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,040 |
3,865 |
$67K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,645 |
1,580 |
$61K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,707 |
2,376 |
$53K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
657 |
655 |
$40K |
| V2750 |
Anti-reflective coating, per lens |
3,564 |
3,317 |
$35K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
507 |
504 |
$34K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,517 |
1,152 |
$27K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
356 |
344 |
$14K |
| V2025 |
Deluxe frame |
1,173 |
1,173 |
$11K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
392 |
323 |
$7K |
| V2430 |
Variable asphericity lens, bifocal, full field, glass or plastic, per lens |
49 |
49 |
$5K |
| V2781 |
Progressive lens, per lens |
109 |
109 |
$4K |
| V2744 |
Tint, photochromatic, per lens |
669 |
640 |
$3K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
20 |
14 |
$387.00 |
| V2755 |
U-v lens, per lens |
174 |
172 |
$140.00 |
| V2799 |
Vision item or service, miscellaneous |
142 |
123 |
$54.90 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
39 |
39 |
$0.00 |