| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,596 |
2,592 |
$174K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,635 |
1,621 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,198 |
1,193 |
$24K |
| V2020 |
Frames, purchases |
955 |
942 |
$17K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
449 |
448 |
$7K |
| V2750 |
Anti-reflective coating, per lens |
1,781 |
1,770 |
$7K |
| V2744 |
Tint, photochromatic, per lens |
308 |
304 |
$2K |
| V2799 |
Vision item or service, miscellaneous |
153 |
149 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
59 |
57 |
$693.61 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$369.16 |