| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,880 |
2,154 |
$125K |
| V2020 |
Frames, purchases |
3,408 |
2,775 |
$102K |
| 92014 |
|
2,726 |
2,673 |
$100K |
| 92004 |
|
1,116 |
1,097 |
$34K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,074 |
1,707 |
$30K |
| V2750 |
Anti-reflective coating, per lens |
1,010 |
497 |
$13K |
| V2760 |
Scratch resistant coating, per lens |
1,055 |
501 |
$7K |
| V2744 |
Tint, photochromatic, per lens |
117 |
63 |
$3K |
| 92012 |
|
25 |
25 |
$1K |
| V2500 |
Contact lens, pmma, spherical, per lens |
13 |
13 |
$631.50 |