| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,478 |
4,197 |
$94K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,173 |
2,894 |
$58K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,237 |
3,872 |
$51K |
| V2025 |
Deluxe frame |
976 |
826 |
$22K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,150 |
1,006 |
$19K |
| V2750 |
Anti-reflective coating, per lens |
996 |
860 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
667 |
571 |
$11K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
234 |
202 |
$6K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
134 |
96 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
85 |
54 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
13 |
$324.16 |