| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,728 |
2,695 |
$61K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,776 |
1,752 |
$35K |
| V2750 |
Anti-reflective coating, per lens |
1,455 |
1,432 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
444 |
436 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
270 |
270 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
74 |
74 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
34 |
34 |
$407.00 |
| V2744 |
Tint, photochromatic, per lens |
56 |
56 |
$325.00 |
| V2799 |
Vision item or service, miscellaneous |
176 |
150 |
$0.00 |