| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
795 |
589 |
$74K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
873 |
638 |
$67K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,280 |
915 |
$41K |
| V2750 |
Anti-reflective coating, per lens |
1,264 |
908 |
$35K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,273 |
918 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
164 |
136 |
$12K |
| V2020 |
Frames, purchases |
101 |
76 |
$6K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
43 |
41 |
$3K |
| V2106 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens |
29 |
27 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
32 |
25 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
13 |
$918.60 |