| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
11,665 |
10,514 |
$158K |
| V2020 |
Frames, purchases |
13,314 |
11,822 |
$150K |
| V2025 |
Deluxe frame |
4,745 |
4,480 |
$117K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
3,202 |
2,896 |
$38K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,977 |
2,729 |
$37K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,590 |
2,321 |
$27K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
691 |
628 |
$18K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
1,508 |
1,326 |
$18K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,022 |
847 |
$15K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
250 |
232 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
199 |
179 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
253 |
234 |
$629.24 |
| V2799 |
Vision item or service, miscellaneous |
185 |
167 |
$353.52 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
13 |
13 |
$154.11 |
| V2781 |
Progressive lens, per lens |
16 |
12 |
$0.00 |