| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,346 |
2,343 |
$169K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,227 |
1,223 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,097 |
1,091 |
$18K |
| V2020 |
Frames, purchases |
388 |
381 |
$7K |
| V2750 |
Anti-reflective coating, per lens |
1,727 |
1,716 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
371 |
370 |
$5K |
| V2744 |
Tint, photochromatic, per lens |
129 |
129 |
$980.37 |
| V2799 |
Vision item or service, miscellaneous |
12 |
12 |
$0.00 |