NPI: 1841282050 · SIOUX CITY, IA 51106 · 152W00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 2,876 | $103K |
| 2019 | 3,604 | $122K |
| 2020 | 2,429 | $92K |
| 2021 | 1,337 | $42K |
| 2022 | 1,753 | $53K |
| 2023 | 19 | $240.80 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 92014 | 2,534 | 2,427 | $157K | |
| 92004 | 1,597 | 1,554 | $143K | |
| V2020 | Vision svcs frames purchases | 2,453 | 2,298 | $62K |
| V2103 | Spherocylindr 4.00d/12-2.00d | 1,428 | 832 | $18K |
| V2100 | Lens spher single plano 4.00 | 853 | 531 | $12K |
| 92015 | 744 | 705 | $9K | |
| 92250 | 168 | 151 | $7K | |
| V2756 | Eye glass case | 2,134 | 2,031 | $2K |
| 99213 | 31 | 26 | $816.67 | |
| V2200 | Lens spher bifoc plano 4.00d | 17 | 13 | $517.16 |
| V2203 | Lens sphcyl bifocal 4.00d/.1 | 23 | 12 | $369.40 |
| V2104 | Spherocylindr 4.00d/2.12-4d | 20 | 12 | $255.20 |
| V2784 | Lens polycarb or equal | 16 | 14 | $17.44 |