| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,530 |
4,918 |
$101K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,348 |
2,093 |
$42K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,261 |
1,152 |
$24K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
348 |
301 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
114 |
104 |
$2K |
| V2781 |
Progressive lens, per lens |
43 |
25 |
$894.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
26 |
25 |
$507.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$460.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
69 |
57 |
$195.78 |
| V2750 |
Anti-reflective coating, per lens |
15 |
15 |
$0.00 |