| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,212 |
3,183 |
$80K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,133 |
2,116 |
$43K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
598 |
595 |
$11K |
| V2750 |
Anti-reflective coating, per lens |
1,826 |
1,807 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
394 |
392 |
$6K |
| V2744 |
Tint, photochromatic, per lens |
142 |
138 |
$728.32 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
90 |
89 |
$698.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$200.50 |