| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,235 |
5,186 |
$73K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,001 |
2,968 |
$72K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,253 |
1,228 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
872 |
847 |
$20K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
134 |
134 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
54 |
54 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
41 |
41 |
$861.82 |
| V2025 |
Deluxe frame |
35 |
35 |
$0.00 |