| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,273 |
1,264 |
$46K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
677 |
658 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,011 |
995 |
$24K |
| V2020 |
Frames, purchases |
1,067 |
1,046 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
244 |
240 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
85 |
84 |
$2K |