COVENANT COMMUNITY CARE, INC.

$1.51M

Total Medicaid Paid

50,217

Total Claims

45,271

Beneficiaries

54

Codes Billed

2018-01

First Month

2022-12

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
G0467	Fqhc visit, estab pt	16,788	14,617	$1.10M
G0470	Fqhc visit, mh estab pt	2,004	1,335	$161K
G0468	Fqhc visit, ippe or awv	1,449	1,410	$93K
G0466	Fqhc visit new patient	752	726	$54K
99213		9,273	8,229	$31K
99214		4,718	4,445	$23K
G0469	Fqhc visit, mh new pt	98	87	$7K
99396		656	645	$5K
90460		1,051	1,009	$3K
0012A		83	83	$3K
99392		335	320	$3K
H0004	Alcohol and/or drug services	1,085	965	$3K
99395		341	333	$3K
90471		1,814	1,756	$2K
0011A		92	92	$2K
99391		323	302	$2K
36415		4,089	3,842	$2K
99203		311	295	$1K
0004A		48	46	$1K
0031A		43	43	$1K
90686		527	516	$562.24
99393		72	71	$493.16
90688		199	189	$481.68
90472		132	123	$414.36
90715		71	66	$392.20
87426		154	147	$367.40
90832		144	127	$332.84
99212		254	241	$295.95
96127		734	697	$286.96
96110		163	160	$274.00
90632		26	25	$235.84
99000		40	40	$196.05
81025		146	140	$185.38
83655		51	51	$185.03
99204		12	12	$183.44
G2025	Dis site tele svcs rhc/fqhc	68	55	$150.64
96160		149	147	$145.68
81002		290	285	$143.37
90674		15	14	$108.00
90756		229	223	$108.00
99202		14	14	$85.18
85018		182	178	$75.48
92551		13	13	$6.54
82962		12	12	$5.42
91301		180	176	$0.00
90698		39	39	$0.00
91303		43	43	$0.00
36416		129	124	$0.00
G0008	Admin influenza virus vac	39	39	$0.00
99173		85	83	$0.00
90670		110	106	$0.00
90461		489	482	$0.00
90662		12	12	$0.00
91300		41	41	$0.00

Medicaid Provider Spending