| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
891 |
589 |
$35K |
| 92014 |
|
827 |
750 |
$30K |
| 92004 |
|
505 |
486 |
$22K |
| V2760 |
Scratch resistant coating, per lens |
1,277 |
434 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
406 |
132 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
400 |
126 |
$11K |
| 92083 |
|
14 |
14 |
$721.35 |
| 92250 |
|
16 |
15 |
$638.04 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
553 |
165 |
$454.73 |
| 92015 |
|
715 |
693 |
$430.00 |
| 92020 |
|
15 |
15 |
$207.50 |
| 76514 |
|
12 |
12 |
$68.83 |