WAL-MART STORES TEXAS, LP
NPI: 1790866705
· GRAND PRAIRIE, TX 75052
· 156FX1800X
$209K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
533 |
$10K |
| 2021 |
2,707 |
$44K |
| 2022 |
2,976 |
$43K |
| 2023 |
3,849 |
$60K |
| 2024 |
3,179 |
$52K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
4,603 |
4,563 |
$109K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,096 |
3,068 |
$57K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,170 |
1,164 |
$19K |
| V2750 |
Anti-reflective coating |
2,756 |
2,731 |
$10K |
| V2100 |
Lens spher single plano 4.00 |
597 |
592 |
$9K |
| V2107 |
Spherocylinder 4.25d/12-2d |
128 |
123 |
$2K |
| V2744 |
Tint photochromatic lens/es |
308 |
304 |
$1K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
70 |
69 |
$951.50 |
| V2784 |
Lens polycarb or equal |
60 |
60 |
$341.65 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
13 |
13 |
$226.50 |
| V2799 |
Misc vision item or service |
443 |
379 |
$57.00 |