| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,721 |
2,685 |
$72K |
| V2020 |
Frames, purchases |
2,043 |
2,009 |
$66K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,610 |
2,587 |
$37K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,188 |
1,180 |
$26K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
511 |
511 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
261 |
261 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
103 |
98 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$618.50 |
| V2750 |
Anti-reflective coating, per lens |
96 |
96 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
12 |
12 |
$0.00 |