| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,678 |
1,675 |
$83K |
| 92014 |
|
1,651 |
1,573 |
$71K |
| V2020 |
Frames, purchases |
2,015 |
1,905 |
$67K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,554 |
1,453 |
$44K |
| 92340 |
|
1,933 |
1,910 |
$29K |
| 92004 |
|
517 |
502 |
$24K |
| 92015 |
|
468 |
444 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
25 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
215 |
105 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,068 |
1,017 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,358 |
1,301 |
$960.50 |
| V2109 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens |
34 |
17 |
$260.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
12 |
$64.00 |
| V2750 |
Anti-reflective coating, per lens |
125 |
124 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
78 |
78 |
$0.00 |