DICKERT, ASHLEY

$7K

Total Medicaid Paid

190

Total Claims

170

Beneficiaries

5

Codes Billed

2019-03

First Month

2019-10

Last Month

Year	Claims	Total Paid
2019	190	$7K

Code	Description	Claims	Beneficiaries	Total Paid
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	104	98	$6K
99214	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	13	12	$624.69
87804	Infectious agent antigen detection by immunoassay; Influenza, each type	26	13	$328.08
90460	Immunization administration through 18 years of age via any route, first or only component	32	32	$322.88
85018		15	15	$24.60

Medicaid Provider Spending