STILLWATER MEDICAL CENTER AUTHORITY

$3.25M

Total Medicaid Paid

39,710

Total Claims

37,609

Beneficiaries

54

Codes Billed

2018-01

First Month

2024-11

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99284		4,461	4,240	$1.06M
99283		6,231	6,067	$1.03M
99285		1,721	1,651	$521K
99282		2,051	2,016	$205K
96374		633	595	$79K
96372		1,262	1,167	$78K
36415		4,765	4,341	$47K
87637		331	329	$45K
87635		318	316	$15K
80053		1,190	1,136	$12K
87880		853	838	$12K
71046		738	727	$12K
80048		1,368	1,287	$12K
85025		1,778	1,700	$11K
70450		204	199	$9K
80076		1,245	1,203	$8K
81001		1,831	1,752	$8K
86710		611	600	$8K
71045		596	567	$7K
85027		1,127	1,076	$6K
87081		612	605	$5K
83605		532	497	$5K
96375		123	106	$4K
80050		142	142	$4K
87804		269	143	$4K
84484		402	352	$4K
96365		23	17	$4K
96361		101	90	$3K
74176		40	40	$3K
87086		339	326	$3K
87088		454	440	$3K
83690		485	457	$3K
93005		562	508	$3K
81025		358	342	$2K
87040		257	129	$2K
74177		14	14	$2K
U0004	Cov-19 test non-cdc hgh thru	18	18	$2K
80307		29	27	$2K
80061		117	117	$1K
83880		40	38	$1K
84436		200	199	$1K
86756		81	79	$1K
82150		82	77	$426.24
72100		14	14	$398.36
84443		13	13	$194.22
85378		25	24	$190.30
87186		24	24	$176.87
87077		24	24	$160.87
82550		13	12	$63.69
J1885	Ketorolac tromethamine inj	792	743	$18.85
J1100	Dexamethasone sodium phos	14	13	$0.00
J2550	Promethazine hcl injection	55	46	$0.00
J7030	Normal saline solution infus	110	94	$0.00
Q9967	Locm 300-399mg/ml iodine,1ml	32	32	$0.00

Medicaid Provider Spending