NPI: 1144333675 · JEFFERSON CITY, MO 65101 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 1,056 | $17K |
| 2019 | 892 | $15K |
| 2020 | 150 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Vision svcs frames purchases | 480 | 460 | $9K |
| 92014 | 182 | 176 | $9K | |
| V2784 | Lens polycarb or equal | 486 | 449 | $6K |
| 92015 | 582 | 568 | $3K | |
| V2103 | Spherocylindr 4.00d/12-2.00d | 251 | 241 | $3K |
| 92004 | 41 | 38 | $2K | |
| 92012 | 38 | 38 | $1K | |
| 92002 | 23 | 23 | $717.90 | |
| V2100 | Lens spher single plano 4.00 | 15 | 13 | $165.00 |