NPI: 1467739888 · SANTO DOMINGO PUEBLO, NM 87052 · 261Q00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 547 | $11K |
| 2019 | 1,374 | $9K |
| 2020 | 660 | $7K |
| 2021 | 2,495 | $1000K |
| 2022 | 983 | $409K |
| 2023 | 167 | $10K |
| 2024 | 13 | $1K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 0064A | 491 | 487 | $259K | |
| 0002A | 316 | 312 | $156K | |
| 0001A | 296 | 292 | $143K | |
| 0003A | 278 | 276 | $134K | |
| 0072A | 224 | 218 | $122K | |
| 0071A | 203 | 201 | $104K | |
| 87635 | 182 | 171 | $90K | |
| 0012A | 188 | 186 | $87K | |
| 0011A | 182 | 180 | $82K | |
| 0124A | 121 | 121 | $74K | |
| 0053A | 120 | 120 | $73K | |
| 0054A | 97 | 97 | $61K | |
| 99213 | 1,386 | 1,228 | $18K | |
| 99000 | 37 | 37 | $17K | |
| 99214 | 469 | 419 | $9K | |
| 42700 | 16 | 15 | $7K | |
| 92567 | 15 | 15 | $3K | |
| 92310 | 12 | 12 | $2K | |
| V2784 | Lens polycarb or equal | 227 | 107 | $2K |
| V2020 | Vision svcs frames purchases | 121 | 111 | $1K |
| 92587 | 14 | 14 | $1K | |
| 36416 | 422 | 385 | $932.61 | |
| V2103 | Spherocylindr 4.00d/12-2.00d | 60 | 26 | $335.16 |
| 99211 | 35 | 20 | $130.24 | |
| 90471 | 16 | 14 | $92.22 | |
| 82962 | 503 | 470 | $59.27 | |
| 83036 | 142 | 142 | $56.00 | |
| 90686 | 12 | 12 | $0.00 | |
| 90694 | 16 | 15 | $0.00 | |
| G0008 | Admin influenza virus vac | 14 | 14 | $0.00 |
| 36415 | 24 | 24 | $0.00 |