NPI: 1528214335 · CALUMET CITY, IL 60409 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 1,113 | $30K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2025 | Eyeglasses delux frames | 221 | 199 | $6K |
| 92014 | 132 | 127 | $6K | |
| 92015 | 298 | 271 | $5K | |
| 92340 | 155 | 147 | $5K | |
| 92004 | 64 | 62 | $3K | |
| 92341 | 58 | 45 | $2K | |
| S0620 | Routine ophthalmological exa | 30 | 30 | $1K |
| V2100 | Lens spher single plano 4.00 | 53 | 51 | $669.50 |
| V2102 | Singl visn sphere 7.12-20.00 | 30 | 29 | $390.00 |
| V2784 | Lens polycarb or equal | 56 | 55 | $350.56 |
| V2101 | Single visn sphere 4.12-7.00 | 16 | 14 | $208.00 |