| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,082 |
4,038 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,943 |
1,636 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,670 |
2,646 |
$11K |
| V2755 |
U-v lens, per lens |
172 |
172 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
354 |
205 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
508 |
279 |
$42.50 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
30 |
15 |
$0.00 |