WAL-MART STORES EAST, LP
NPI: 1134217938
· MANCHESTER, CT 06042
· 156FX1800X
$191K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
3,663 |
$19K |
| 2019 |
2,629 |
$41K |
| 2020 |
929 |
$21K |
| 2021 |
2,082 |
$30K |
| 2022 |
2,346 |
$22K |
| 2023 |
3,050 |
$30K |
| 2024 |
2,342 |
$27K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
10,138 |
6,480 |
$117K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,908 |
3,829 |
$69K |
| V2100 |
Lens spher single plano 4.00 |
686 |
450 |
$4K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
140 |
130 |
$573.85 |
| V2781 |
Progressive lens per lens |
14 |
13 |
$0.00 |
| V2750 |
Anti-reflective coating |
143 |
97 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
12 |
12 |
$0.00 |