NPI: 1427669746 · LA CROSSE, WI 54601 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 196 | $469.00 |
| 2023 | 13,765 | $2K |
| 2024 | 11,335 | $167K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Vision svcs frames purchases | 6,835 | 5,794 | $66K |
| V2100 | Lens spher single plano 4.00 | 4,517 | 3,868 | $45K |
| 92014 | 2,974 | 2,483 | $32K | |
| 92015 | 6,282 | 5,243 | $17K | |
| V2025 | Eyeglasses delux frames | 1,923 | 1,664 | $5K |
| V2784 | Lens polycarb or equal | 2,587 | 2,200 | $3K |
| 92004 | 166 | 135 | $2K | |
| V2200 | Lens spher bifoc plano 4.00d | 12 | 12 | $0.00 |