NPI: 1184791642 · MONTICELLO, IA 52310 · 332H00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2019 | 773 | $14K |
| 2020 | 599 | $9K |
| 2021 | 1,257 | $29K |
| 2022 | 1,188 | $27K |
| 2023 | 1,249 | $28K |
| 2024 | 808 | $18K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Vision svcs frames purchases | 1,204 | 1,164 | $29K |
| 92014 | 451 | 444 | $28K | |
| 92015 | 1,893 | 1,850 | $26K | |
| 92012 | 407 | 401 | $19K | |
| V2103 | Spherocylindr 4.00d/12-2.00d | 297 | 291 | $7K |
| 92250 | 131 | 128 | $5K | |
| 92004 | 41 | 41 | $4K | |
| 92083 | 101 | 95 | $4K | |
| V2784 | Lens polycarb or equal | 105 | 102 | $1K |
| V2756 | Eye glass case | 1,149 | 1,112 | $1K |
| V2100 | Lens spher single plano 4.00 | 27 | 26 | $671.15 |
| 92081 | 30 | 30 | $165.91 | |
| 92285 | 12 | 12 | $59.25 | |
| S0621 | Routine ophthalmological exa | 26 | 26 | $0.00 |