1912014382

1912014382 was paid $52K by Medicaid between Nov 2020 and Jun 2021, across 5 billing codes. Its largest line is S0621, Routine ophthalmological examination including refraction; established patient — 42% of everything it billed.

33Billing provider info1912014382

33aNPI1912014382

33bProvider type—

28Total paid$52K

24GClaims1,915

24DCodes billed5

24AFirst – last monthNov 2020 – Jun 2021

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2020	485	$13K
2021	1,430	$39K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
S0621	Routine ophthalmological examination including refraction; established patient	42%	537	533	$22K
V2100	Sphere, single vision, plano to plus or minus 4.00, per lens	20%	535	534	$11K
V2782	Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens	13%	314	313	$7K
V2025	Deluxe frame	13%	135	134	$7K
V2020	Frames, purchases	12%	394	390	$6K

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.