| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
5,956 |
5,913 |
$457K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,162 |
3,984 |
$64K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,563 |
3,498 |
$63K |
| V2020 |
Frames, purchases |
2,990 |
2,813 |
$43K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,257 |
1,211 |
$17K |
| V2750 |
Anti-reflective coating, per lens |
4,110 |
4,062 |
$11K |
| V2744 |
Tint, photochromatic, per lens |
841 |
830 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
221 |
216 |
$3K |
| V2799 |
Vision item or service, miscellaneous |
735 |
633 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
263 |
256 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
97 |
95 |
$1K |