| Code | Description | Claims | Beneficiaries | Total Paid |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
565 |
459 |
$32K |
| V2020 |
Frames, purchases |
504 |
460 |
$30K |
| 92004 |
|
142 |
129 |
$17K |
| 92340 |
|
457 |
421 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
269 |
221 |
$11K |
| 92083 |
|
179 |
174 |
$10K |
| 92250 |
|
179 |
175 |
$9K |
| V2750 |
Anti-reflective coating, per lens |
489 |
447 |
$8K |
| V2760 |
Scratch resistant coating, per lens |
445 |
417 |
$7K |
| V2755 |
U-v lens, per lens |
430 |
405 |
$5K |
| V2109 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens |
89 |
84 |
$4K |
| 92283 |
|
88 |
88 |
$4K |
| 92015 |
|
188 |
175 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
64 |
56 |
$3K |
| 92014 |
|
14 |
14 |
$2K |
| V2219 |
Bifocal seg width over 28 mm |
23 |
23 |
$809.83 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$797.68 |
| 92326 |
|
16 |
16 |
$428.40 |