NPI: 1588184386 · JEFFERSON CITY, MO 65109 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 1,905 | $30K |
| 2019 | 4,453 | $91K |
| 2020 | 630 | $13K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 92014 | 929 | 876 | $43K | |
| V2020 | Vision svcs frames purchases | 1,276 | 1,226 | $24K |
| 92004 | 513 | 491 | $24K | |
| V2784 | Lens polycarb or equal | 1,315 | 1,252 | $19K |
| V2103 | Spherocylindr 4.00d/12-2.00d | 1,011 | 960 | $11K |
| 92015 | 1,476 | 1,399 | $7K | |
| V2100 | Lens spher single plano 4.00 | 370 | 351 | $4K |
| V2104 | Spherocylindr 4.00d/2.12-4d | 98 | 92 | $2K |