NPI: 1003301235 · SAN ANTONIO, TX 78229 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 12 | $582.70 |
| 2023 | 956 | $19K |
| 2024 | 525 | $9K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| S0621 | Routine ophthalmological exa | 220 | 220 | $9K |
| V2784 | Lens polycarb or equal | 297 | 292 | $6K |
| V2020 | Vision svcs frames purchases | 217 | 213 | $4K |
| V2103 | Spherocylindr 4.00d/12-2.00d | 194 | 190 | $4K |
| S0620 | Routine ophthalmological exa | 82 | 82 | $3K |
| V2025 | Eyeglasses delux frames | 15 | 15 | $754.52 |
| V2100 | Lens spher single plano 4.00 | 12 | 12 | $582.70 |
| 92015 | 441 | 441 | $0.00 | |
| S9986 | Not medically necessary svc | 15 | 15 | $0.00 |