| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,088 |
3,878 |
$57K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,771 |
2,630 |
$42K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,708 |
1,617 |
$21K |
| V2750 |
Anti-reflective coating, per lens |
1,933 |
1,836 |
$20K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
925 |
866 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
730 |
693 |
$9K |
| V2799 |
Vision item or service, miscellaneous |
1,164 |
1,090 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
45 |
41 |
$344.76 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
38 |
37 |
$297.66 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
13 |
12 |
$296.91 |
| V2702 |
Deluxe lens feature |
126 |
118 |
$276.91 |
| V2755 |
U-v lens, per lens |
28 |
25 |
$61.25 |