| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,785 |
5,753 |
$106K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,647 |
3,629 |
$71K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,422 |
1,415 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
909 |
903 |
$14K |
| V2750 |
Anti-reflective coating, per lens |
2,583 |
2,571 |
$7K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
187 |
187 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
78 |
77 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
145 |
144 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
42 |
$427.00 |
| V2799 |
Vision item or service, miscellaneous |
112 |
110 |
$0.00 |