| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,432 |
1,428 |
$92K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
678 |
670 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
739 |
737 |
$12K |
| V2750 |
Anti-reflective coating, per lens |
1,783 |
1,768 |
$9K |
| V2020 |
Frames, purchases |
195 |
189 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
84 |
82 |
$689.37 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
41 |
41 |
$567.08 |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$174.48 |
| V2799 |
Vision item or service, miscellaneous |
23 |
12 |
$95.13 |