WAL-MART STORES TEXAS, LLC
NPI: 1104352459
· GRAND PRAIRIE, TX 75052
· 156FX1800X
$128K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
122 |
$2K |
| 2021 |
2,743 |
$44K |
| 2022 |
2,754 |
$36K |
| 2023 |
1,653 |
$28K |
| 2024 |
1,017 |
$18K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
2,968 |
2,924 |
$61K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,134 |
2,105 |
$37K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
572 |
570 |
$9K |
| V2750 |
Anti-reflective coating |
1,769 |
1,747 |
$9K |
| V2025 |
Eyeglasses delux frames |
149 |
149 |
$7K |
| V2100 |
Lens spher single plano 4.00 |
253 |
249 |
$4K |
| V2784 |
Lens polycarb or equal |
169 |
168 |
$760.66 |
| V2744 |
Tint photochromatic lens/es |
56 |
56 |
$315.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
12 |
12 |
$199.50 |
| V2799 |
Misc vision item or service |
207 |
189 |
$150.41 |