| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,523 |
4,460 |
$129K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,745 |
2,712 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,568 |
1,545 |
$24K |
| V2750 |
Anti-reflective coating, per lens |
2,465 |
2,433 |
$16K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
619 |
610 |
$10K |
| V2025 |
Deluxe frame |
166 |
166 |
$4K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
109 |
106 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
713 |
705 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
297 |
292 |
$571.45 |
| V2799 |
Vision item or service, miscellaneous |
104 |
98 |
$10.00 |