| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
13,702 |
13,572 |
$84K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14,531 |
9,056 |
$64K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,961 |
4,225 |
$33K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,687 |
1,682 |
$30K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
4,063 |
2,694 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,841 |
965 |
$42.00 |
| V2744 |
Tint, photochromatic, per lens |
266 |
132 |
$0.00 |
| V2781 |
Progressive lens, per lens |
74 |
37 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
74 |
37 |
$0.00 |
| V2755 |
U-v lens, per lens |
86 |
43 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
24 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
1,114 |
553 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
476 |
236 |
$0.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
80 |
40 |
$0.00 |