Clinic
Custom Eyes RX INC
Custom Eyes RX INC was paid $370K by Medicaid between Mar 2020 and Dec 2024, across 11 billing codes. Its largest line is V2784, Lens, polycarbonate or equal, any index, per lens — 41% of everything it billed.
33Billing provider infoCUSTOM EYES RX INC
MATAMORAS, PA 18336
MATAMORAS, PA 18336
33aNPI1982732715assigned 03/01/2007
33bProvider typeHealth Service Clinic/Center
28Total paid$370K
24GClaims13,064
24DCodes billed11
24AFirst – last monthMar 2020 – Dec 2024
Compared with peers
Next to other Health Service Clinic/Center providers in Pennsylvania
Rank by total paid#4 of 12
Median peer was paid$42K
This provider vs. median8.9×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
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 | 1,218 | $28K | |
| 2021 | 2,832 | $82K | |
| 2022 | 2,917 | $81K | |
| 2023 | 3,542 | $100K | |
| 2024incomplete | 2,555 | $79K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| V2784 | Lens, polycarbonate or equal, any index, per lens | 41% | 3,089 | 2,244 | $151K |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | 22% | 2,858 | 2,012 | $82K |
| 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | 19% | 1,609 | 1,578 | $71K |
| 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | 8.0% | 548 | 540 | $29K |
| V2020 | Frames, purchases | 6.4% | 2,828 | 2,263 | $24K |
| 92015 | Determination of refractive state | 2.7% | 2,017 | 1,986 | $10K |
| V2200 | Sphere, bifocal, plano to plus or minus 4.00d, per lens | <1% | 48 | 39 | $2K |
| V2300 | Sphere, trifocal, plano to plus or minus 4.00d, per lens | <1% | 15 | 12 | $750.00 |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | <1% | 13 | 12 | $288.50 |
| V2750 | Anti-reflective coating, per lens | 0% | 26 | 12 | $0.00 |
| V2745 | Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens | 0% | 13 | 12 | $0.00 |
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.
From NPPES
Who's on the registration
Authorized officialLIEGNER, JEFFREY (MEDICAL DIRECTOR)