| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,933 |
6,689 |
$140K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,720 |
3,546 |
$71K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,529 |
1,519 |
$54K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,847 |
2,819 |
$41K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,324 |
1,251 |
$25K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
288 |
283 |
$11K |
| V2025 |
Deluxe frame |
747 |
746 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
301 |
296 |
$5K |
| V2750 |
Anti-reflective coating, per lens |
646 |
639 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
66 |
66 |
$1K |
| V2781 |
Progressive lens, per lens |
25 |
25 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
132 |
129 |
$304.30 |