| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
375 |
375 |
$46K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
938 |
938 |
$40K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
945 |
944 |
$40K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
172 |
172 |
$17K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
213 |
206 |
$15K |
| 92015 |
Determination of refractive state |
45 |
45 |
$711.64 |