| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,087 |
2,736 |
$19K |
| V2020 |
Frames, purchases |
3,798 |
3,779 |
$18K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,913 |
1,125 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,738 |
2,153 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
127 |
81 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
24 |
12 |
$0.00 |