| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,302 |
1,009 |
$66K |
| V2025 |
Deluxe frame |
857 |
856 |
$61K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,152 |
1,141 |
$22K |
| V2750 |
Anti-reflective coating, per lens |
576 |
572 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
75 |
75 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
108 |
108 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$360.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$149.00 |