Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

GWEN FUENTES MD PEDIATRIC CLINIC

NPI: 1083830608 · ARDMORE, OK 73401 · Pediatrics Physician · NPI assigned 04/18/2007

$1.88M
Total Medicaid Paid
45,541
Total Claims
44,131
Beneficiaries
52
Codes Billed
2018-01
First Month
2024-12
Last Month

Provider Details

Authorized OfficialFUENTES, GWEN (OWNER)
NPI Enumeration Date04/18/2007

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 8,276 $278K
2019 8,238 $291K
2020 7,421 $264K
2021 7,306 $319K
2022 6,816 $343K
2023 5,767 $288K
2024 1,717 $93K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity 7,799 7,066 $571K
90460 Immunization administration through 18 years of age via any route, first or only component 5,227 5,190 $186K
99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) 1,905 1,905 $176K
99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) 1,580 1,580 $160K
99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) 1,682 1,680 $156K
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward 3,604 3,350 $139K
99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity 1,205 1,172 $137K
99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) 1,483 1,408 $129K
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 4,696 4,535 $68K
92567 2,082 2,058 $28K
92587 1,412 1,400 $27K
87811 Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) 549 523 $21K
87804 Infectious agent antigen detection by immunoassay; Influenza, each type 562 549 $16K
87426 Infectious agent antigen detection, SARS-CoV-2 (COVID-19) 226 220 $10K
99441 207 202 $7K
92551 738 737 $7K
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction 418 411 $6K
96110 Developmental screening, with scoring and documentation, per standardized instrument 610 608 $5K
99188 392 392 $4K
90480 105 105 $4K
83655 333 333 $4K
99173 1,339 1,339 $3K
85013 336 336 $2K
0072A 49 49 $2K
0071A 47 47 $2K
94010 62 61 $2K
87807 43 42 $518.36
91319 27 27 $0.02
90686 1,633 1,632 $0.02
90688 501 501 $0.01
90670 755 755 $0.00
90715 85 85 $0.00
96160 1,272 1,271 $0.00
90671 191 191 $0.00
90648 286 286 $0.00
90707 172 172 $0.00
90633 137 137 $0.00
90687 16 16 $0.00
90734 167 167 $0.00
90710 25 25 $0.00
91320 13 13 $0.00
90685 21 21 $0.00
90651 562 562 $0.00
90680 299 299 $0.00
G0447 Face-to-face behavioral counseling for obesity, 15 minutes 177 177 $0.00
91307 113 98 $0.00
90716 164 164 $0.00
90620 92 92 $0.00
90723 66 66 $0.00
90656 29 29 $0.00
90619 35 35 $0.00
90697 12 12 $0.00