| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,770 |
1,712 |
$44K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
646 |
632 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
481 |
465 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,106 |
1,076 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
77 |
75 |
$2K |
| V2756 |
Eye glass case |
1,544 |
1,503 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
54 |
53 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
16 |
13 |
$229.68 |