NPI: 1699337915 · LAREDO, TX 78041 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 140 | $3K |
| 2024 | 1,244 | $24K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 92014 | 168 | 168 | $17K | |
| 92004 | 35 | 35 | $4K | |
| V2020 | Vision svcs frames purchases | 180 | 173 | $4K |
| V2103 | Spherocylindr 4.00d/12-2.00d | 125 | 71 | $1K |
| V2104 | Spherocylindr 4.00d/2.12-4d | 46 | 29 | $621.69 |
| V2784 | Lens polycarb or equal | 222 | 108 | $460.00 |
| 92015 | 240 | 240 | $31.78 | |
| G9905 | No pt tbco scrn rng | 156 | 155 | $0.00 |
| G9903 | Pt scrn tbco id as non user | 106 | 106 | $0.00 |
| 1036F | 106 | 106 | $0.00 |