| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
4,518 |
4,506 |
$310K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,409 |
3,372 |
$55K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,686 |
2,658 |
$48K |
| V2020 |
Frames, purchases |
2,233 |
2,195 |
$37K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,010 |
994 |
$14K |
| V2750 |
Anti-reflective coating, per lens |
2,944 |
2,916 |
$12K |
| V2744 |
Tint, photochromatic, per lens |
461 |
454 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
119 |
119 |
$903.08 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
59 |
58 |
$759.39 |
| V2799 |
Vision item or service, miscellaneous |
310 |
296 |
$408.02 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
27 |
27 |
$319.57 |