| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
4,764 |
4,711 |
$196K |
| V2020 |
Frames, purchases |
6,033 |
5,929 |
$113K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,745 |
4,657 |
$111K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
669 |
634 |
$29K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
826 |
816 |
$20K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
715 |
701 |
$17K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
632 |
624 |
$16K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
178 |
173 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
112 |
109 |
$2K |
| 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 |
$317.22 |