| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
999 |
998 |
$42K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
904 |
904 |
$38K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
123 |
123 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
75 |
75 |
$9K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
27 |
$2K |
| 92015 |
Determination of refractive state |
37 |
37 |
$580.62 |