| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
371 |
362 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
481 |
460 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
47 |
47 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
111 |
109 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
38 |
36 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
238 |
220 |
$0.00 |