| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,990 |
2,581 |
$95K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,915 |
1,609 |
$38K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
717 |
692 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
428 |
369 |
$9K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$995.00 |
| V2025 |
Deluxe frame |
87 |
87 |
$870.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$250.50 |
| V2750 |
Anti-reflective coating, per lens |
562 |
522 |
$0.00 |