| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
349 |
313 |
$5K |
| V2020 |
Frames, purchases |
796 |
791 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
224 |
207 |
$4K |
| V2781 |
Progressive lens, per lens |
57 |
51 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
388 |
364 |
$2K |
| V2799 |
Vision item or service, miscellaneous |
12 |
12 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
20 |
14 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
269 |
244 |
$0.00 |
| V2025 |
Deluxe frame |
405 |
402 |
$0.00 |