NPI: 1720500168 · COPPELL, TX 75019 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 473 | $12K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| S0621 | Routine ophthalmological exa | 135 | 135 | $8K |
| S0620 | Routine ophthalmological exa | 79 | 79 | $4K |
| V2020 | Vision svcs frames purchases | 70 | 70 | $200.00 |
| V2784 | Lens polycarb or equal | 12 | 12 | $143.00 |
| V2103 | Spherocylindr 4.00d/12-2.00d | 15 | 15 | $140.00 |
| S9986 | Not medically necessary svc | 12 | 12 | $0.00 |
| 92015 | 58 | 58 | $0.00 | |
| V2100 | Lens spher single plano 4.00 | 92 | 92 | $0.00 |