| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
11,242 |
11,173 |
$95K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,811 |
5,900 |
$59K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,715 |
4,155 |
$57K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
3,357 |
2,690 |
$51K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,364 |
1,706 |
$148.50 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
284 |
143 |
$27.00 |
| V2750 |
Anti-reflective coating, per lens |
623 |
309 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
417 |
208 |
$0.00 |
| V2781 |
Progressive lens, per lens |
581 |
290 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
313 |
164 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
52 |
25 |
$0.00 |