| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
892 |
889 |
$59K |
| V2020 |
Frames, purchases |
1,481 |
1,388 |
$58K |
| V2750 |
Anti-reflective coating, per lens |
2,072 |
1,990 |
$37K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,673 |
1,604 |
$30K |
| V2744 |
Tint, photochromatic, per lens |
547 |
523 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
243 |
235 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
157 |
154 |
$2K |
| V2799 |
Vision item or service, miscellaneous |
300 |
169 |
$917.90 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
45 |
44 |
$570.49 |