| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,462 |
2,459 |
$171K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,280 |
1,277 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,030 |
1,014 |
$16K |
| V2750 |
Anti-reflective coating, per lens |
1,370 |
1,361 |
$5K |
| V2020 |
Frames, purchases |
259 |
250 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
308 |
303 |
$4K |
| V2799 |
Vision item or service, miscellaneous |
416 |
253 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
25 |
25 |
$48.52 |