| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
105 |
97 |
$351.08 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
35 |
25 |
$106.50 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
16 |
12 |
$66.32 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
30 |
24 |
$40.62 |
| 92250 |
|
75 |
52 |
$27.59 |
| 92015 |
Determination of refractive state |
172 |
150 |
$14.68 |
| 67028 |
Intravitreal injection of a pharmacologic agent |
22 |
14 |
$0.00 |