| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,717 |
2,709 |
$57K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,472 |
1,470 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,153 |
1,151 |
$9K |
| 92002 |
|
143 |
143 |
$8K |
| 92014 |
|
36 |
36 |
$2K |
| V2781 |
Progressive lens, per lens |
26 |
26 |
$116.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
14 |
$44.50 |
| V2025 |
Deluxe frame |
135 |
135 |
$0.00 |