| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
6,330 |
6,311 |
$445K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,489 |
3,472 |
$66K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,739 |
3,707 |
$63K |
| V2020 |
Frames, purchases |
2,687 |
2,622 |
$43K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,411 |
1,393 |
$20K |
| V2750 |
Anti-reflective coating, per lens |
2,850 |
2,831 |
$11K |
| V2799 |
Vision item or service, miscellaneous |
1,260 |
1,158 |
$8K |
| V2744 |
Tint, photochromatic, per lens |
737 |
735 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
642 |
634 |
$6K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
229 |
225 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
69 |
68 |
$3K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
201 |
199 |
$3K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
16 |
15 |
$201.85 |