| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,241 |
4,744 |
$138K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,678 |
3,307 |
$74K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,202 |
1,123 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,679 |
1,653 |
$22K |
| V2025 |
Deluxe frame |
747 |
744 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
1,277 |
1,240 |
$5K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
27 |
27 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
88 |
75 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
37 |
37 |
$826.00 |
| V2744 |
Tint, photochromatic, per lens |
26 |
26 |
$140.60 |