| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,897 |
3,243 |
$150K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,001 |
1,256 |
$108K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,852 |
595 |
$50K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
8,707 |
2,765 |
$12K |
| V2750 |
Anti-reflective coating, per lens |
149 |
70 |
$4K |
| V2744 |
Tint, photochromatic, per lens |
102 |
46 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
76 |
26 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
35 |
12 |
$1K |