| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
595 |
552 |
$43K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,216 |
1,115 |
$40K |
| 92014 |
|
951 |
888 |
$32K |
| V2020 |
Frames, purchases |
1,408 |
1,317 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
118 |
106 |
$2K |
| 92340 |
|
1,604 |
1,486 |
$2K |
| 92015 |
|
1,664 |
1,563 |
$142.00 |
| V2025 |
Deluxe frame |
243 |
217 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
45 |
44 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
141 |
134 |
$0.00 |