| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,448 |
2,924 |
$95K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,054 |
1,679 |
$39K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
286 |
245 |
$6K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
77 |
77 |
$5K |
| V2750 |
Anti-reflective coating, per lens |
508 |
448 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
192 |
185 |
$3K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
31 |
31 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$601.60 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
20 |
12 |
$0.00 |