WAL-MART STORES EAST, LP
NPI: 1205918869
· ALLENTOWN, PA 18106
· 156FX1800X
$486K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
1,752 |
$40K |
| 2021 |
5,505 |
$138K |
| 2022 |
4,569 |
$120K |
| 2023 |
4,276 |
$112K |
| 2024 |
2,529 |
$76K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylindr 4.00d/12-2.00d |
6,511 |
3,115 |
$205K |
| V2020 |
Vision svcs frames purchases |
6,989 |
5,322 |
$173K |
| V2100 |
Lens spher single plano 4.00 |
1,545 |
937 |
$56K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
684 |
352 |
$21K |
| V2107 |
Spherocylinder 4.25d/12-2d |
368 |
203 |
$11K |
| V2200 |
Lens spher bifoc plano 4.00d |
219 |
126 |
$9K |
| V2115 |
Lens lenticular bifocal |
86 |
65 |
$7K |
| V2750 |
Anti-reflective coating |
744 |
501 |
$2K |
| V2781 |
Progressive lens per lens |
126 |
70 |
$977.45 |
| V2744 |
Tint photochromatic lens/es |
566 |
305 |
$565.00 |
| V2784 |
Lens polycarb or equal |
793 |
393 |
$153.00 |