| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
5,034 |
5,026 |
$327K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,972 |
2,955 |
$55K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,371 |
3,323 |
$54K |
| V2020 |
Frames, purchases |
2,257 |
2,214 |
$35K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
982 |
974 |
$14K |
| V2750 |
Anti-reflective coating, per lens |
2,864 |
2,849 |
$13K |
| V2744 |
Tint, photochromatic, per lens |
1,030 |
1,022 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
507 |
503 |
$4K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
138 |
137 |
$2K |
| V2799 |
Vision item or service, miscellaneous |
408 |
358 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
61 |
59 |
$806.55 |