NPI: 1801936463 · GRAND PRAIRIE, TX 75052 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 84 | $952.00 |
| 2021 | 740 | $10K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Vision svcs frames purchases | 237 | 229 | $6K |
| S0620 | Routine ophthalmological exa | 104 | 100 | $2K |
| V2100 | Lens spher single plano 4.00 | 223 | 217 | $2K |
| S0621 | Routine ophthalmological exa | 48 | 47 | $844.75 |
| V2750 | Anti-reflective coating | 17 | 17 | $240.00 |
| V2784 | Lens polycarb or equal | 195 | 187 | $26.00 |