NPI: 1134119761 · N SIOUX CITY, SD 57049 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 7,197 | $212K |
| 2019 | 6,481 | $186K |
| 2020 | 2,010 | $53K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 92004 | 1,256 | 1,237 | $112K | |
| 92014 | 1,146 | 1,131 | $73K | |
| V2020 | Vision svcs frames purchases | 2,400 | 2,304 | $60K |
| 92065 | 1,982 | 685 | $60K | |
| 99214 | 855 | 716 | $54K | |
| 92060 | 822 | 656 | $39K | |
| V2103 | Spherocylindr 4.00d/12-2.00d | 1,701 | 1,334 | $28K |
| 99213 | 226 | 190 | $9K | |
| V2100 | Lens spher single plano 4.00 | 392 | 345 | $6K |
| S0621 | Routine ophthalmological exa | 34 | 33 | $2K |
| V2756 | Eye glass case | 2,243 | 2,173 | $2K |
| V2104 | Spherocylindr 4.00d/2.12-4d | 78 | 69 | $1K |
| 97530 | 51 | 16 | $938.96 | |
| 97110 | 36 | 15 | $628.72 | |
| 92015 | 2,407 | 2,362 | $518.95 | |
| V2203 | Lens sphcyl bifocal 4.00d/.1 | 19 | 18 | $480.22 |
| 92370 | 25 | 25 | $360.00 | |
| S0620 | Routine ophthalmological exa | 15 | 14 | $0.00 |