| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2025 |
Deluxe frame |
603 |
602 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
465 |
461 |
$9K |
| V2020 |
Frames, purchases |
166 |
165 |
$4K |
| V2755 |
U-v lens, per lens |
832 |
826 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
804 |
798 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
42 |
41 |
$847.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
29 |
$546.59 |