WAL-MART STORES EAST, LP
NPI: 1174605083
· ANTIGO, WI 54409
· 156FX1800X
$407.00
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
15 |
$190.00 |
| 2023 |
59 |
$217.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
34 |
28 |
$407.00 |
| 92015 |
|
40 |
25 |
$0.00 |