| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
10,395 |
10,392 |
$734K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,938 |
3,938 |
$422K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,272 |
2,233 |
$156K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,147 |
2,091 |
$85K |
| 92015 |
Determination of refractive state |
3,721 |
3,721 |
$65K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
618 |
600 |
$40K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
281 |
281 |
$36K |
| 67028 |
Intravitreal injection of a pharmacologic agent |
901 |
886 |
$15K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
110 |
110 |
$10K |
| 92083 |
|
343 |
342 |
$10K |
| 92134 |
|
1,737 |
1,717 |
$10K |
| J9035 |
Injection, bevacizumab, 10 mg |
337 |
305 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
106 |
105 |
$3K |
| J7999 |
Compounded drug, not otherwise classified |
95 |
85 |
$2K |
| 92133 |
|
40 |
40 |
$719.93 |
| 67228 |
|
14 |
12 |
$590.86 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
21 |
21 |
$585.90 |
| V2020 |
Frames, purchases |
30 |
30 |
$300.00 |