| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
5,963 |
5,958 |
$377K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,569 |
3,547 |
$66K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,678 |
3,656 |
$60K |
| V2020 |
Frames, purchases |
2,167 |
2,134 |
$33K |
| V2750 |
Anti-reflective coating, per lens |
3,954 |
3,936 |
$25K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
999 |
992 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,088 |
1,073 |
$9K |
| V2744 |
Tint, photochromatic, per lens |
519 |
517 |
$7K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
137 |
137 |
$2K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
43 |
43 |
$675.26 |
| V2799 |
Vision item or service, miscellaneous |
251 |
222 |
$540.30 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
13 |
13 |
$188.10 |