WAL-MART STORES EAST, LP
NPI: 1629159090
· YORK, PA 17402
· 156FX1800X
$171K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
243 |
$7K |
| 2021 |
1,609 |
$42K |
| 2022 |
1,741 |
$51K |
| 2023 |
1,466 |
$46K |
| 2024 |
803 |
$25K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,639 |
1,012 |
$60K |
| V2020 |
Vision svcs frames purchases |
2,923 |
2,385 |
$58K |
| 92002 |
|
554 |
553 |
$22K |
| V2100 |
Lens spher single plano 4.00 |
555 |
393 |
$22K |
| V2115 |
Lens lenticular bifocal |
75 |
60 |
$7K |
| 92004 |
|
20 |
20 |
$800.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
17 |
12 |
$727.80 |
| 92012 |
|
15 |
15 |
$600.00 |
| V2744 |
Tint photochromatic lens/es |
22 |
13 |
$150.00 |
| V2750 |
Anti-reflective coating |
42 |
41 |
$30.00 |