| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,603 |
4,563 |
$109K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,096 |
3,068 |
$57K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,170 |
1,164 |
$19K |
| V2750 |
Anti-reflective coating, per lens |
2,756 |
2,731 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
597 |
592 |
$9K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
128 |
123 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
308 |
304 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
70 |
69 |
$951.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
60 |
60 |
$341.65 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$226.50 |
| V2799 |
Vision item or service, miscellaneous |
443 |
379 |
$57.00 |