| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
201 |
166 |
$10K |
| 92250 |
|
205 |
171 |
$3K |
| 92015 |
Determination of refractive state |
134 |
114 |
$818.65 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
12 |
$617.70 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
21 |
13 |
$336.71 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
12 |
$224.34 |