| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
826 |
825 |
$66K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
765 |
747 |
$13K |
| V2020 |
Frames, purchases |
551 |
504 |
$10K |
| V2750 |
Anti-reflective coating, per lens |
319 |
310 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
27 |
27 |
$388.79 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
17 |
17 |
$275.93 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
25 |
$83.00 |
| V2799 |
Vision item or service, miscellaneous |
16 |
14 |
$0.00 |