| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,814 |
1,810 |
$102K |
| V2020 |
Frames, purchases |
2,565 |
2,290 |
$86K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,475 |
2,298 |
$47K |
| V2750 |
Anti-reflective coating, per lens |
2,176 |
2,123 |
$42K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,003 |
974 |
$19K |
| V2744 |
Tint, photochromatic, per lens |
309 |
307 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
354 |
338 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
142 |
142 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$354.45 |
| V2799 |
Vision item or service, miscellaneous |
13 |
13 |
$30.00 |