| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
3,397 |
2,995 |
$209K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,277 |
1,989 |
$48K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
983 |
861 |
$23K |
| V2020 |
Frames, purchases |
1,331 |
1,093 |
$22K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
214 |
179 |
$14K |
| V2750 |
Anti-reflective coating, per lens |
288 |
245 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
47 |
45 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
115 |
109 |
$2K |
| V2781 |
Progressive lens, per lens |
28 |
24 |
$2K |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
25 |
24 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
37 |
26 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$228.19 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
16 |
$168.00 |