| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
3,599 |
3,586 |
$265K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,773 |
1,758 |
$35K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,118 |
2,075 |
$34K |
| V2020 |
Frames, purchases |
1,084 |
1,050 |
$16K |
| V2750 |
Anti-reflective coating, per lens |
3,051 |
3,033 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
631 |
625 |
$9K |
| V2744 |
Tint, photochromatic, per lens |
460 |
459 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
258 |
256 |
$2K |
| V2799 |
Vision item or service, miscellaneous |
233 |
216 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$210.00 |