NPI: 1295112530 · MANCHESTER, NH 03101 · 261QF0400X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 34,968 | $1.97M |
| 2019 | 26,956 | $1.60M |
| 2020 | 28,629 | $1.86M |
| 2021 | 27,824 | $1.97M |
| 2022 | 18,327 | $1.50M |
| 2023 | 12,727 | $1.14M |
| 2024 | 15,204 | $1.54M |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| T1015 | Clinic service | 65,066 | 46,914 | $11.34M |
| T1027 | Family training & counseling | 8,838 | 5,295 | $105K |
| 90460 | 13,133 | 10,748 | $21K | |
| 92015 | 2,604 | 2,138 | $17K | |
| T1023 | Program intake assessment | 103 | 102 | $16K |
| 92340 | 541 | 470 | $10K | |
| G0467 | Fqhc visit, estab pt | 685 | 436 | $10K |
| 90832 | 8,417 | 3,671 | $7K | |
| V2020 | Vision svcs frames purchases | 1,071 | 939 | $6K |
| V2103 | Spherocylindr 4.00d/12-2.00d | 607 | 333 | $6K |
| 90834 | 2,754 | 1,626 | $6K | |
| 90461 | 6,826 | 5,327 | $6K | |
| 92014 | 3,118 | 2,548 | $5K | |
| 86328 | 159 | 149 | $4K | |
| 90686 | 6,218 | 5,344 | $3K | |
| 87880 | 396 | 358 | $3K | |
| 99213 | 16,862 | 14,041 | $3K | |
| V2750 | Anti-reflective coating | 124 | 108 | $2K |
| 96110 | 755 | 655 | $2K | |
| V2760 | Scratch resistant coating | 1,088 | 618 | $2K |
| 99214 | 4,025 | 3,420 | $2K | |
| 99177 | 297 | 255 | $2K | |
| 90648 | 1,518 | 1,213 | $1K | |
| V2755 | Uv lens/es | 565 | 487 | $1K |
| V2100 | Lens spher single plano 4.00 | 252 | 227 | $799.24 |
| 90633 | 314 | 234 | $792.00 | |
| 87804 | 79 | 74 | $788.02 | |
| 90723 | 753 | 614 | $657.27 | |
| 90480 | 35 | 31 | $640.00 | |
| 99394 | 1,905 | 1,549 | $498.89 | |
| 92551 | 202 | 172 | $498.44 | |
| 90867 | 18 | 16 | $306.00 | |
| 90670 | 881 | 726 | $276.50 | |
| 99401 | 776 | 269 | $270.00 | |
| 99391 | 3,187 | 2,495 | $269.82 | |
| 90656 | 327 | 293 | $264.71 | |
| V2784 | Lens polycarb or equal | 130 | 120 | $239.14 |
| 87400 | 51 | 46 | $205.08 | |
| 90471 | 127 | 105 | $203.46 | |
| 90680 | 428 | 343 | $192.00 | |
| 83655 | 27 | 24 | $139.36 | |
| 90707 | 76 | 70 | $73.71 | |
| 99393 | 3,715 | 3,167 | $67.95 | |
| 99392 | 3,726 | 3,137 | $67.95 | |
| 85018 | 65 | 51 | $62.16 | |
| 90677 | 70 | 63 | $0.00 | |
| 90620 | 45 | 39 | $0.00 | |
| 90651 | 186 | 150 | $0.00 | |
| 90716 | 102 | 93 | $0.00 | |
| 92004 | 44 | 40 | $0.00 | |
| 36416 | 30 | 25 | $0.00 | |
| 90697 | 50 | 43 | $0.00 | |
| 90847 | 16 | 14 | $0.00 | |
| 90669 | 549 | 379 | $0.00 | |
| 91321 | 15 | 14 | $0.00 | |
| 99173 | 182 | 164 | $0.00 | |
| 99212 | 175 | 142 | $0.00 | |
| 90837 | 20 | 15 | $0.00 | |
| 90687 | 20 | 16 | $0.00 | |
| 90791 | 40 | 36 | $0.00 | |
| 90734 | 162 | 124 | $0.00 | |
| 90853 | 70 | 12 | $0.00 | |
| 99203 | 15 | 12 | $0.00 |