NPI: 1831198548 · SAN ANTONIO, TX 78228 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 1,131 | $25K |
| 2021 | 2,463 | $50K |
| 2022 | 517 | $11K |
| 2023 | 38 | $797.11 |
| 2024 | 41 | $339.56 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2025 | Eyeglasses delux frames | 558 | 550 | $20K |
| V2020 | Vision svcs frames purchases | 691 | 669 | $14K |
| 92014 | 206 | 203 | $11K | |
| V2103 | Spherocylindr 4.00d/12-2.00d | 634 | 624 | $10K |
| V2100 | Lens spher single plano 4.00 | 277 | 261 | $6K |
| V2750 | Anti-reflective coating | 434 | 425 | $5K |
| 92004 | 66 | 66 | $5K | |
| S0621 | Routine ophthalmological exa | 102 | 101 | $4K |
| V2784 | Lens polycarb or equal | 504 | 491 | $3K |
| 92015 | 461 | 443 | $3K | |
| V2104 | Spherocylindr 4.00d/2.12-4d | 176 | 171 | $2K |
| S0620 | Routine ophthalmological exa | 51 | 51 | $2K |
| V2744 | Tint photochromatic lens/es | 14 | 13 | $44.01 |
| S9986 | Not medically necessary svc | 16 | 13 | $0.00 |