SOKAOGON CHIPPEWA COMMUNITY

$590K

Total Medicaid Paid

21,360

Total Claims

13,785

Beneficiaries

43

Codes Billed

2018-01

First Month

2024-12

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
87635		3,912	2,682	$151K
99214		2,237	1,629	$83K
H0022	Alcohol and/or drug intervention service (planned facilitation)	1,505	795	$68K
99213		2,678	1,736	$56K
90837		825	448	$56K
99211		3,797	2,579	$41K
98941		1,608	638	$29K
90834		520	325	$24K
87811		790	524	$21K
90832		441	278	$18K
87502		78	73	$6K
D0140		315	258	$5K
D1110		207	154	$4K
D1208		382	286	$4K
99215	Prolong outpt/office vis	49	38	$3K
D0220		390	297	$2K
D0120		202	164	$2K
90833		72	41	$2K
87634		30	28	$2K
0012A		61	61	$2K
D0150		164	76	$2K
87651		40	38	$1K
D0210		34	24	$1K
D2391		29	13	$1K
D1354		144	52	$977.70
D2392		20	13	$911.24
0013A		17	16	$572.40
D2940		24	14	$570.49
0011A		35	35	$559.02
99000		242	160	$380.24
D1120		12	12	$366.60
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit	59	31	$359.93
99212		12	12	$229.56
D0274		45	15	$225.51
D1206		12	12	$161.45
80048		33	27	$97.88
96127		34	15	$71.88
36415		21	15	$8.57
D1999		54	37	$0.00
T1015	Clinic visit/encounter, all-inclusive	16	16	$0.00
98943		151	56	$0.00
91301		35	35	$0.00
D1330		28	27	$0.00

Medicaid Provider Spending