| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,858 |
1,680 |
$37K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
714 |
583 |
$27K |
| 92014 |
|
402 |
393 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
191 |
169 |
$8K |
| 92012 |
|
180 |
180 |
$7K |
| 92002 |
|
66 |
66 |
$3K |
| 92004 |
|
33 |
27 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
444 |
400 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
13 |
$1K |
| V2025 |
Deluxe frame |
12 |
12 |
$761.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
64 |
38 |
$429.00 |
| 92015 |
|
16 |
16 |
$280.00 |
| V2799 |
Vision item or service, miscellaneous |
12 |
12 |
$145.00 |