WAL-MART STORES EAST, LP
NPI: 1265513261
· TOMAH, WI 54660
· 156FX1800X
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
2,372 |
$44K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
1,350 |
1,349 |
$22K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
704 |
703 |
$17K |
| V2100 |
Lens spher single plano 4.00 |
114 |
114 |
$2K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
39 |
39 |
$841.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
12 |
12 |
$619.50 |
| V2750 |
Anti-reflective coating |
83 |
83 |
$0.00 |
| V2781 |
Progressive lens per lens |
70 |
70 |
$0.00 |