| Code | Description | Claims | Beneficiaries | Total Paid |
| V2020 |
Frames, purchases |
3,696 |
3,459 |
$189K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,087 |
1,556 |
$92K |
| V2755 |
U-v lens, per lens |
3,282 |
2,413 |
$60K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
704 |
572 |
$44K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
636 |
488 |
$27K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
33 |
30 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
14 |
$990.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
12 |
$688.02 |