| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,550 |
1,540 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
372 |
370 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
560 |
559 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
24 |
$379.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
37 |
37 |
$23.56 |
| V2750 |
Anti-reflective coating, per lens |
301 |
298 |
$0.00 |