| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,392 |
2,382 |
$103K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,224 |
1,129 |
$59K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
478 |
433 |
$36K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
646 |
615 |
$34K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
885 |
880 |
$28K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
47 |
47 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
44 |
42 |
$2K |