SHOPKO STORES OPERATING CO. LLC
NPI: 1083667638
· KENOSHA, WI 53144
· 332H00000X
$102K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
2,639 |
$72K |
| 2019 |
1,060 |
$30K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,026 |
861 |
$36K |
| V2020 |
Vision svcs frames purchases |
681 |
612 |
$18K |
| 92004 |
|
329 |
299 |
$12K |
| 92340 |
|
584 |
575 |
$12K |
| V2100 |
Lens spher single plano 4.00 |
561 |
501 |
$12K |
| 92341 |
|
176 |
175 |
$5K |
| V2784 |
Lens polycarb or equal |
298 |
261 |
$4K |
| V2200 |
Lens spher bifoc plano 4.00d |
44 |
42 |
$2K |