| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
620 |
521 |
$38K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
749 |
658 |
$31K |
| 92341 |
|
810 |
728 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
907 |
795 |
$26K |
| V2020 |
Frames, purchases |
297 |
276 |
$12K |
| V2760 |
Scratch resistant coating, per lens |
902 |
793 |
$12K |
| V2755 |
U-v lens, per lens |
599 |
513 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$420.84 |