NPI: 1114132644 · LA JUNTA, CO 81050 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 4,669 | $163K |
| 2022 | 5,382 | $199K |
| 2023 | 547 | $24K |
| 2024 | 183 | $5K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 92014 | 1,046 | 914 | $94K | |
| 92004 | 649 | 567 | $67K | |
| V2781 | Progressive lens per lens | 984 | 826 | $60K |
| V2020 | Vision svcs frames purchases | 1,174 | 968 | $40K |
| V2103 | Spherocylindr 4.00d/12-2.00d | 897 | 742 | $35K |
| V2750 | Anti-reflective coating | 1,320 | 1,085 | $31K |
| 92340 | 1,367 | 1,116 | $22K | |
| V2784 | Lens polycarb or equal | 1,320 | 1,084 | $21K |
| V2410 | Lens variab asphericity sing | 223 | 170 | $15K |
| V2104 | Spherocylindr 4.00d/2.12-4d | 76 | 65 | $3K |
| V2100 | Lens spher single plano 4.00 | 44 | 39 | $2K |
| 92015 | 1,662 | 1,501 | $678.96 | |
| V2744 | Tint photochromatic lens/es | 19 | 15 | $207.86 |