| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,588 |
3,549 |
$66K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,278 |
2,257 |
$45K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
796 |
789 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
320 |
319 |
$5K |
| V2750 |
Anti-reflective coating, per lens |
1,399 |
1,383 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
143 |
139 |
$965.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
26 |
25 |
$430.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$122.00 |
| V2799 |
Vision item or service, miscellaneous |
16 |
14 |
$0.00 |