NPI: 1720242258 · SAN BERNARDINO, CA 92410 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 2,343 | $55K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 92014 | 436 | 412 | $17K | |
| 92004 | 271 | 263 | $11K | |
| V2020 | Vision svcs frames purchases | 431 | 408 | $9K |
| 92015 | 709 | 676 | $6K | |
| 92340 | 199 | 189 | $4K | |
| V2100 | Lens spher single plano 4.00 | 178 | 168 | $3K |
| 92225 | 32 | 32 | $2K | |
| 92342 | 55 | 54 | $2K | |
| 92134 | 17 | 17 | $700.91 | |
| V2784 | Lens polycarb or equal | 15 | 15 | $84.89 |