| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
46 |
46 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
50 |
50 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
90 |
90 |
$4K |
| 92015 |
Determination of refractive state |
129 |
129 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
29 |
29 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
12 |
$886.26 |