WAL-MART STORES, INC. · NPI 1225286511

NPI: 1225286511 · KING OF PRUSSIA, PA 19406 · Eyewear Supplier · NPI assigned 08/29/2008

$5.74M

Total Medicaid Paid

157,009

Total Claims

137,919

Beneficiaries

Codes Billed

2018-01

First Month

2024-11

Last Month

Provider Details

Authorized Official	SUTTON, SABRINA (NPI ASSOCIATE)
NPI Enumeration Date	08/29/2008

Related Entities

Provider	City	State	Total Paid
WAL-MART STORES, INC.	OMAHA	NE	$207K
WAL-MART STORES EAST, LP	CINCINNATI(EVENDALE)	OH	$176K
WAL-MART STORES EAST, LP	NEW BOSTON	OH	$149K
SAM'S CLUB OPTICAL	DEPTFORD	NJ	$54K
WAL-MART STORES, INC.	OSWEGO	IL	$43K
WAL-MART STORES INC.	GALESBURG	IL	$33K
WAL-MART STORES EAST, LP	SHREVEPORT	LA	$28K
WAL-MART STORES, INC.	LOCKPORT	IL	$26K
WAL-MART STORES EAST, LP	WAVELAND	MS	$22K
WAL-MART STORES, INC.	LINCOLN	NE	$9K
WAL-MART STORES, INC.	RUIDOSO DOWNS	NM	$5K
WAL-MART STORES, INC.	RANTOUL	IL	$971.00
WAL-MART STORES EAST, LP	BREAUX BRIDGE	LA	$785.00

Monthly Spending Trend

Yearly Breakdown

Year	Claims	Total Paid
2018	2,768	$100K
2019	2,972	$42K
2020	9,444	$301K
2021	35,288	$1.29M
2022	46,262	$1.82M
2023	40,459	$1.49M
2024	19,816	$702K

Billing Codes

Code	Description	Claims	Beneficiaries	Total Paid
V2025	Deluxe frame	47,596	41,390	$2.85M
V2103	Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens	29,987	26,597	$505K
V2781	Progressive lens, per lens	5,073	4,146	$417K
V2520	Contact lens, hydrophilic, spherical, per lens	4,165	3,708	$268K
V2744	Tint, photochromatic, per lens	4,139	3,599	$227K
V2521	Contact lens, hydrophilic, toric, or prism ballast, per lens	3,081	2,733	$198K
V2020	Frames, purchases	7,898	7,296	$197K
V2523	Contact lens, hydrophilic, extended wear, per lens	2,607	2,208	$164K
V2203	Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens	4,652	4,042	$163K
S0620	Routine ophthalmological examination including refraction; new patient	3,025	3,023	$136K
V2100	Sphere, single vision, plano to plus or minus 4.00, per lens	8,851	7,948	$124K
V2750	Anti-reflective coating, per lens	10,114	8,958	$119K
V2784	Lens, polycarbonate or equal, any index, per lens	7,895	6,952	$91K
S0621	Routine ophthalmological examination including refraction; established patient	1,722	1,721	$78K
V2104	Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens	4,384	3,893	$61K
V2107	Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens	3,504	3,048	$52K
V2200	Sphere, bifocal, plano to plus or minus 4.00d, per lens	990	861	$26K
S0592	Comprehensive contact lens evaluation	622	620	$19K
V2500	Contact lens, pmma, spherical, per lens	261	261	$16K
V2108	Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens	879	784	$12K
V2105	Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens	527	454	$7K
V2111	Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens	308	253	$5K
V2101	Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens	247	217	$3K
V2204	Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens	107	101	$3K
V2755	U-v lens, per lens	167	167	$1K
V2207	Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens	17	17	$537.50
V2783	Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens	883	645	$396.00
V2109	Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens	13	13	$160.00
V2799	Vision item or service, miscellaneous	2,155	1,432	$64.00
V2702	Deluxe lens feature	1,140	832	$0.00