| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,216 |
3,813 |
$76K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,165 |
2,828 |
$67K |
| V2750 |
Anti-reflective coating, per lens |
1,682 |
1,550 |
$49K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,740 |
3,457 |
$31K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
857 |
743 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
543 |
500 |
$12K |
| V2025 |
Deluxe frame |
472 |
384 |
$11K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
87 |
84 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
45 |
44 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$480.00 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$302.83 |
| V2799 |
Vision item or service, miscellaneous |
61 |
61 |
$0.00 |