| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
4,228 |
4,213 |
$288K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,294 |
2,282 |
$43K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,441 |
2,416 |
$41K |
| V2020 |
Frames, purchases |
1,309 |
1,272 |
$21K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
660 |
652 |
$10K |
| V2750 |
Anti-reflective coating, per lens |
1,561 |
1,551 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
573 |
568 |
$5K |
| V2744 |
Tint, photochromatic, per lens |
227 |
226 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
113 |
109 |
$2K |
| V2799 |
Vision item or service, miscellaneous |
185 |
179 |
$733.65 |