| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,742 |
2,513 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,247 |
1,202 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
183 |
177 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
283 |
262 |
$460.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
161 |
134 |
$252.00 |
| V2781 |
Progressive lens, per lens |
76 |
56 |
$29.00 |
| V2744 |
Tint, photochromatic, per lens |
90 |
84 |
$0.00 |