WAL-MART STORES EAST, LP
NPI: 1104361500
· STOUGHTON, WI 53589
· 156FX1800X
$116K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
12 |
$0.00 |
| 2020 |
2,828 |
$50K |
| 2021 |
3,895 |
$66K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
4,100 |
3,944 |
$62K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,923 |
1,850 |
$46K |
| V2781 |
Progressive lens per lens |
27 |
27 |
$2K |
| V2100 |
Lens spher single plano 4.00 |
120 |
117 |
$2K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
24 |
24 |
$1K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
24 |
24 |
$478.50 |
| V2107 |
Spherocylinder 4.25d/12-2d |
14 |
12 |
$246.50 |
| V2784 |
Lens polycarb or equal |
94 |
86 |
$132.00 |
| 92004 |
|
160 |
152 |
$0.00 |
| V2750 |
Anti-reflective coating |
249 |
237 |
$0.00 |