NPI: 1003296120 · O FALLON, MO 63368 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 2,301 | $33K |
| 2019 | 1,664 | $34K |
| 2020 | 320 | $7K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 92014 | 481 | 413 | $20K | |
| 92004 | 458 | 375 | $18K | |
| V2020 | Vision svcs frames purchases | 922 | 760 | $15K |
| V2784 | Lens polycarb or equal | 663 | 569 | $12K |
| V2103 | Spherocylindr 4.00d/12-2.00d | 531 | 438 | $5K |
| 92015 | 1,065 | 885 | $4K | |
| V2100 | Lens spher single plano 4.00 | 139 | 97 | $1K |
| V2744 | Tint photochromatic lens/es | 26 | 12 | $110.00 |