NPI: 1558845669 · MANCHESTER, NH 03101 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2019 | 94 | $3K |
| 2020 | 681 | $21K |
| 2021 | 132 | $4K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 92014 | 341 | 328 | $13K | |
| V2020 | Vision svcs frames purchases | 205 | 181 | $8K |
| 99213 | 74 | 60 | $3K | |
| V2103 | Spherocylindr 4.00d/12-2.00d | 47 | 47 | $2K |
| 92340 | 80 | 78 | $1K | |
| S0580 | Polycarb lens | 43 | 41 | $948.00 |
| V2755 | Uv lens/es | 26 | 26 | $263.16 |
| V2100 | Lens spher single plano 4.00 | 13 | 13 | $149.50 |
| 92004 | 21 | 13 | $0.00 | |
| T1015 | Clinic service | 44 | 40 | $0.00 |
| V2760 | Scratch resistant coating | 13 | 13 | $0.00 |