NPI: 1609069814 · ERIE, PA 16506 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 190 | $7K |
| 2021 | 983 | $34K |
| 2022 | 974 | $35K |
| 2023 | 1,188 | $43K |
| 2024 | 1,046 | $33K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Vision svcs frames purchases | 1,501 | 1,487 | $78K |
| V2100 | Lens spher single plano 4.00 | 927 | 920 | $30K |
| S0621 | Routine ophthalmological exa | 633 | 631 | $19K |
| S0620 | Routine ophthalmological exa | 413 | 413 | $12K |
| V2784 | Lens polycarb or equal | 440 | 438 | $8K |
| V2760 | Scratch resistant coating | 192 | 192 | $2K |
| V2200 | Lens spher bifoc plano 4.00d | 15 | 15 | $690.00 |
| 92004 | 50 | 50 | $603.25 | |
| 92015 | 190 | 185 | $579.15 | |
| 92014 | 20 | 18 | $70.00 |