WAL-MART STORES EAST, LP
NPI: 1235228206
· WATERBURY, CT 06705
· 156FX1800X
$327K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
6,597 |
$37K |
| 2019 |
4,965 |
$79K |
| 2020 |
1,709 |
$39K |
| 2021 |
4,676 |
$67K |
| 2022 |
4,188 |
$39K |
| 2023 |
3,546 |
$36K |
| 2024 |
2,888 |
$30K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
16,280 |
10,700 |
$188K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
8,786 |
5,872 |
$103K |
| V2100 |
Lens spher single plano 4.00 |
1,995 |
1,410 |
$19K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
893 |
685 |
$16K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
234 |
178 |
$1K |
| V2781 |
Progressive lens per lens |
87 |
63 |
$0.00 |
| S0580 |
Polycarb lens |
30 |
29 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
24 |
13 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
81 |
51 |
$0.00 |
| V2750 |
Anti-reflective coating |
159 |
143 |
$0.00 |