| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,125 |
2,079 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,376 |
1,343 |
$27K |
| V2750 |
Anti-reflective coating, per lens |
952 |
936 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
114 |
112 |
$2K |
| V2025 |
Deluxe frame |
27 |
27 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
38 |
38 |
$639.75 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
39 |
39 |
$247.19 |
| 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 |
$214.00 |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$0.00 |