WAL-MART STORES EAST, LP
NPI: 1033295233
· HARTFORD, CT 06106
· 156FX1800X
$229K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
4,997 |
$25K |
| 2019 |
4,087 |
$63K |
| 2020 |
1,451 |
$34K |
| 2021 |
3,866 |
$47K |
| 2022 |
1,298 |
$14K |
| 2023 |
2,618 |
$28K |
| 2024 |
1,705 |
$18K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
12,038 |
7,696 |
$137K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,469 |
3,511 |
$63K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
914 |
496 |
$15K |
| V2100 |
Lens spher single plano 4.00 |
1,238 |
826 |
$13K |
| V2107 |
Spherocylinder 4.25d/12-2d |
35 |
18 |
$348.00 |
| V2744 |
Tint photochromatic lens/es |
69 |
37 |
$300.72 |
| V2750 |
Anti-reflective coating |
168 |
99 |
$0.00 |
| V2781 |
Progressive lens per lens |
67 |
45 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
24 |
13 |
$0.00 |