| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,377 |
2,377 |
$167K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,821 |
1,820 |
$95K |
| 92015 |
Determination of refractive state |
4,165 |
4,165 |
$54K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
238 |
233 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
321 |
318 |
$16K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
58 |
25 |
$14K |