| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,501 |
2,087 |
$154K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,663 |
1,355 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
651 |
503 |
$16K |
| V2020 |
Frames, purchases |
892 |
680 |
$16K |
| V2781 |
Progressive lens, per lens |
22 |
12 |
$2K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
13 |
12 |
$913.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
72 |
69 |
$756.00 |
| V2750 |
Anti-reflective coating, per lens |
46 |
42 |
$425.90 |