| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,928 |
2,796 |
$49K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,346 |
1,319 |
$29K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
699 |
641 |
$11K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
81 |
81 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
125 |
124 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
70 |
70 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
28 |
$565.76 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |