| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,271 |
1,116 |
$28K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,300 |
990 |
$14K |
| D1110 |
Prophylaxis - adult |
178 |
133 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
173 |
138 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
325 |
260 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
214 |
160 |
$3K |
| D1206 |
Topical application of fluoride varnish |
54 |
54 |
$2K |
| 92250 |
|
159 |
128 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
39 |
34 |
$785.08 |
| 92083 |
|
24 |
24 |
$250.74 |
| 92134 |
|
33 |
24 |
$50.85 |
| 92133 |
|
15 |
12 |
$49.85 |