| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
12,505 |
12,254 |
$757K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
7,962 |
7,790 |
$173K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,820 |
3,761 |
$75K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
1,129 |
1,119 |
$24K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,031 |
1,013 |
$20K |
| V2781 |
Progressive lens, per lens |
45 |
45 |
$931.00 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
30 |
30 |
$539.50 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
16 |
14 |
$238.50 |
| V2744 |
Tint, photochromatic, per lens |
601 |
596 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
64 |
62 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
124 |
119 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
5,291 |
5,168 |
$0.00 |