WAL-MART STORES TEXAS, LLC
NPI: 1316020878
· ARLINGTON, TX 76011
· 156FX1800X
$173K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
591 |
$7K |
| 2021 |
3,355 |
$44K |
| 2022 |
3,409 |
$45K |
| 2023 |
3,094 |
$47K |
| 2024 |
1,663 |
$29K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
4,783 |
4,525 |
$84K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,009 |
2,945 |
$58K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
974 |
941 |
$16K |
| V2100 |
Lens spher single plano 4.00 |
500 |
488 |
$8K |
| V2750 |
Anti-reflective coating |
1,916 |
1,876 |
$4K |
| V2107 |
Spherocylinder 4.25d/12-2d |
127 |
127 |
$2K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
94 |
92 |
$2K |
| V2744 |
Tint photochromatic lens/es |
133 |
127 |
$313.61 |
| V2784 |
Lens polycarb or equal |
74 |
71 |
$264.00 |
| V2799 |
Misc vision item or service |
502 |
439 |
$54.75 |