| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Eyeglasses delux frames |
762 |
403 |
$16K |
| 92340 |
|
752 |
392 |
$8K |
| 92004 |
|
77 |
75 |
$5K |
| V2430 |
Lens variable asphericity bi |
12 |
12 |
$1K |
| 92341 |
|
55 |
55 |
$790.73 |
| 92342 |
|
12 |
12 |
$360.00 |
| 92015 |
|
14 |
13 |
$183.21 |
| V2755 |
Uv lens/es |
380 |
113 |
$145.68 |
| V2220 |
Lens bifocal add over 3.25d |
12 |
12 |
$66.66 |
| V2745 |
Tint, any color/solid/grad |
13 |
13 |
$39.52 |
| V2205 |
Lens sphcy bifocal 4.00d/4.2 |
349 |
263 |
$36.00 |
| V2410 |
Lens variab asphericity sing |
69 |
14 |
$0.00 |
| V2102 |
Singl visn sphere 7.12-20.00 |
218 |
138 |
$0.00 |
| V2300 |
Lens sphere trifocal 4.00d |
242 |
54 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
121 |
116 |
$0.00 |
| V2715 |
Prism lens/es |
133 |
47 |
$0.00 |
| V2784 |
Lens polycarb or equal |
54 |
24 |
$0.00 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
284 |
65 |
$0.00 |