WAL-MART STORES EAST, LP
NPI: 1063581031
· WEST MIFFLIN, PA 15122
· 156FX1800X
$166K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
194 |
$7K |
| 2021 |
1,525 |
$45K |
| 2022 |
938 |
$30K |
| 2023 |
660 |
$19K |
| 2024 |
1,669 |
$64K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,107 |
960 |
$58K |
| V2020 |
Vision svcs frames purchases |
2,504 |
2,150 |
$36K |
| V2100 |
Lens spher single plano 4.00 |
564 |
483 |
$30K |
| V2025 |
Eyeglasses delux frames |
360 |
360 |
$20K |
| V2115 |
Lens lenticular bifocal |
152 |
129 |
$16K |
| V2520 |
Contact lens hydrophilic |
26 |
26 |
$2K |
| V2750 |
Anti-reflective coating |
138 |
138 |
$2K |
| V2784 |
Lens polycarb or equal |
90 |
89 |
$1K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
16 |
15 |
$535.69 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
13 |
13 |
$516.00 |
| V2755 |
Uv lens/es |
16 |
16 |
$112.00 |