NPI: 1538150867 · MELROSE PARK, IL 60160 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 4,464 | $159K |
| 2019 | 3,709 | $129K |
| 2020 | 1,279 | $46K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2100 | Lens spher single plano 4.00 | 1,719 | 1,254 | $90K |
| 92004 | 1,418 | 1,230 | $62K | |
| 92014 | 1,285 | 1,102 | $55K | |
| V2025 | Eyeglasses delux frames | 1,583 | 1,210 | $31K |
| 92340 | 929 | 890 | $27K | |
| 92015 | 1,249 | 1,189 | $22K | |
| 92012 | 413 | 387 | $19K | |
| V2200 | Lens spher bifoc plano 4.00d | 116 | 81 | $16K |
| S0620 | Routine ophthalmological exa | 105 | 105 | $5K |
| S0621 | Routine ophthalmological exa | 104 | 104 | $5K |
| V2020 | Vision svcs frames purchases | 146 | 96 | $2K |
| 92341 | 57 | 56 | $2K | |
| V2103 | Spherocylindr 4.00d/12-2.00d | 33 | 24 | $434.00 |
| V2784 | Lens polycarb or equal | 91 | 89 | $132.50 |
| V2750 | Anti-reflective coating | 108 | 43 | $0.00 |
| V2760 | Scratch resistant coating | 66 | 49 | $0.00 |
| V2799 | Misc vision item or service | 16 | 16 | $0.00 |
| S0581 | Nonstnd lens | 14 | 14 | $0.00 |