| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,893 |
2,861 |
$62K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,920 |
1,898 |
$38K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
425 |
425 |
$7K |
| V2750 |
Anti-reflective coating, per lens |
1,341 |
1,329 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
169 |
167 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
194 |
194 |
$730.53 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
13 |
13 |
$220.00 |
| V2799 |
Vision item or service, miscellaneous |
16 |
16 |
$0.00 |