WAL-MART STORES EAST, LP
NPI: 1538240981
· HERMITAGE, PA 16148
· 156FX1800X
$102K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
202 |
$7K |
| 2021 |
1,018 |
$29K |
| 2022 |
688 |
$19K |
| 2023 |
325 |
$9K |
| 2024 |
964 |
$38K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
1,412 |
1,218 |
$31K |
| V2025 |
Eyeglasses delux frames |
465 |
465 |
$29K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
829 |
601 |
$24K |
| V2100 |
Lens spher single plano 4.00 |
409 |
337 |
$16K |
| V2784 |
Lens polycarb or equal |
53 |
52 |
$593.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
16 |
13 |
$303.28 |
| V2750 |
Anti-reflective coating |
13 |
13 |
$154.00 |