| 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 |
868 |
833 |
$19K |
| V2025 |
Deluxe frame |
813 |
778 |
$19K |
| V2020 |
Frames, purchases |
577 |
554 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,162 |
1,122 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
147 |
145 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$230.86 |
| V2750 |
Anti-reflective coating, per lens |
54 |
52 |
$17.21 |