NPI: 1639784622 · GREEN BAY, WI 54303 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 72 | $3K |
| 2021 | 1,181 | $38K |
| 2022 | 2,385 | $75K |
| 2023 | 3,613 | $101K |
| 2024 | 3,358 | $94K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Vision svcs frames purchases | 2,667 | 2,332 | $81K |
| 92004 | 1,828 | 1,768 | $73K | |
| V2100 | Lens spher single plano 4.00 | 2,284 | 1,999 | $56K |
| 92014 | 1,332 | 1,210 | $56K | |
| 92340 | 919 | 912 | $19K | |
| V2784 | Lens polycarb or equal | 869 | 754 | $16K |
| 92015 | 497 | 478 | $5K | |
| 92250 | 150 | 147 | $4K | |
| 92341 | 36 | 36 | $921.50 | |
| V2200 | Lens spher bifoc plano 4.00d | 14 | 14 | $609.44 |
| 92310 | 13 | 13 | $0.00 |