WAL-MART STORES EAST, LP
NPI: 1437234374
· PONTOTOC, MS 38863
· 156FX1800X
$386K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
8,912 |
$129K |
| 2019 |
7,567 |
$127K |
| 2020 |
4,410 |
$76K |
| 2021 |
3,105 |
$54K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
14,499 |
13,988 |
$193K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
8,325 |
7,972 |
$173K |
| V2100 |
Lens spher single plano 4.00 |
948 |
894 |
$17K |
| V2781 |
Progressive lens per lens |
145 |
145 |
$2K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
12 |
12 |
$203.00 |
| V2025 |
Eyeglasses delux frames |
65 |
46 |
$0.00 |