| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
543 |
532 |
$39K |
| V2020 |
Frames, purchases |
1,181 |
1,131 |
$34K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
883 |
847 |
$34K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
349 |
333 |
$13K |
| V2755 |
U-v lens, per lens |
868 |
834 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
45 |
43 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
29 |
27 |
$2K |