NPI: 1497881882 · ISABELA, PR 00662 · 332H00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 1,678 | $37K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Vision svcs frames purchases | 766 | 410 | $26K |
| V2100 | Lens spher single plano 4.00 | 439 | 255 | $8K |
| V2750 | Anti-reflective coating | 265 | 146 | $2K |
| V2744 | Tint photochromatic lens/es | 75 | 39 | $773.00 |
| V2103 | Spherocylindr 4.00d/12-2.00d | 108 | 53 | $415.50 |
| V2784 | Lens polycarb or equal | 25 | 13 | $110.00 |