| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,414 |
1,404 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
904 |
900 |
$19K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
227 |
225 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
108 |
108 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$262.50 |
| V2750 |
Anti-reflective coating, per lens |
823 |
815 |
$50.00 |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
17 |
13 |
$0.00 |