| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,486 |
2,371 |
$75K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,323 |
4,189 |
$68K |
| V2020 |
Frames, purchases |
2,464 |
2,437 |
$47K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,964 |
2,857 |
$44K |
| V2750 |
Anti-reflective coating, per lens |
1,347 |
1,298 |
$16K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,205 |
1,136 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
463 |
436 |
$6K |
| V2744 |
Tint, photochromatic, per lens |
81 |
81 |
$2K |
| V2799 |
Vision item or service, miscellaneous |
138 |
138 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
56 |
51 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
74 |
70 |
$1K |
| 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 |
12 |
$173.78 |