| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,830 |
5,982 |
$139K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,219 |
3,629 |
$80K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,897 |
2,525 |
$33K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
573 |
472 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
361 |
323 |
$7K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
319 |
284 |
$6K |
| V2756 |
Eye glass case |
3,741 |
3,333 |
$3K |