| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
7,514 |
7,435 |
$159K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,723 |
4,672 |
$97K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,586 |
1,570 |
$28K |
| V2750 |
Anti-reflective coating, per lens |
4,725 |
4,686 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
889 |
882 |
$16K |
| V2744 |
Tint, photochromatic, per lens |
1,348 |
1,343 |
$8K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
390 |
387 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
353 |
348 |
$4K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
199 |
198 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
44 |
44 |
$2K |
| V2025 |
Deluxe frame |
12 |
12 |
$846.53 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
38 |
38 |
$667.00 |
| V2799 |
Vision item or service, miscellaneous |
3,656 |
3,093 |
$455.78 |