| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
4,416 |
4,401 |
$302K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,124 |
3,092 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,387 |
2,357 |
$43K |
| V2020 |
Frames, purchases |
1,775 |
1,735 |
$27K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
807 |
795 |
$11K |
| V2750 |
Anti-reflective coating, per lens |
1,871 |
1,857 |
$8K |
| V2744 |
Tint, photochromatic, per lens |
417 |
416 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
202 |
202 |
$1K |
| V2799 |
Vision item or service, miscellaneous |
280 |
261 |
$969.88 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
41 |
41 |
$678.11 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
13 |
13 |
$196.41 |