NPI: 1013925791 · ELIZABETHTON, TN 37643 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 12 | $77.00 |
| 2023 | 102 | $264.00 |
| 2024 | 506 | $3K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 92340 | 129 | 89 | $1K | |
| 92014 | 30 | 29 | $1K | |
| 92015 | 102 | 101 | $700.00 | |
| 92004 | 13 | 12 | $480.00 | |
| V2784 | Lens polycarb or equal | 126 | 89 | $2.50 |
| V2103 | Spherocylindr 4.00d/12-2.00d | 46 | 46 | $0.00 |
| V2100 | Lens spher single plano 4.00 | 32 | 25 | $0.00 |
| V2020 | Vision svcs frames purchases | 142 | 101 | $0.00 |