WAL-MART STORES EAST, LP
NPI: 1598848871
· RAYMORE, MO 64083
· 156FX1800X
$276K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
246 |
$4K |
| 2019 |
115 |
$2K |
| 2020 |
80 |
$3K |
| 2021 |
1,830 |
$44K |
| 2022 |
3,803 |
$91K |
| 2023 |
5,880 |
$133K |
| 2024 |
15 |
$98.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
5,810 |
5,732 |
$94K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,831 |
2,765 |
$47K |
| 92002 |
|
959 |
740 |
$45K |
| 92004 |
|
938 |
904 |
$44K |
| V2744 |
Tint photochromatic lens/es |
270 |
269 |
$19K |
| V2025 |
Eyeglasses delux frames |
257 |
238 |
$18K |
| 92012 |
|
87 |
56 |
$4K |
| 92014 |
|
80 |
80 |
$4K |
| V2100 |
Lens spher single plano 4.00 |
72 |
72 |
$1K |
| V2799 |
Misc vision item or service |
25 |
25 |
$250.00 |
| V2784 |
Lens polycarb or equal |
14 |
14 |
$168.00 |
| 92015 |
|
626 |
597 |
$0.00 |