1104918614

1104918614 was paid $92K by Medicaid between Jan 2018 and Jun 2019, across 26 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 52% of everything it billed.

33Billing provider info1104918614

33aNPI1104918614

33bProvider type—

28Total paid$92K

24GClaims4,259

24DCodes billed26

24AFirst – last monthJan 2018 – Jun 2019

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	3,588	$67K
2019	671	$25K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99214	Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	52%	481	319	$48K
99391	Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year)	20%	545	539	$19K
96150		7.5%	365	299	$7K
92551		4.3%	469	467	$4K
97802		3.5%	102	101	$3K
83655		2.3%	94	94	$2K
96110	Developmental screening, with scoring and documentation, per standardized instrument	2.2%	30	30	$2K
G8510	Screening for depression is documented as negative, a follow-up plan is not required	1.4%	25	25	$1K
99381		1.2%	16	13	$1K
99173		1.0%	494	482	$955.54
90658		<1%	92	92	$823.76
81001		<1%	316	314	$767.26

14 more codes

96127	<1%	157	$581.90
85999	<1%	341	$529.76
85018	<1%	185	$468.69
90686	<1%	48	$423.00
90649	<1%	33	$297.00
81002	<1%	14	$89.51
86580	<1%	169	$47.46
92552	<1%	13	$0.13
81007	<1%	13	$0.13
81000	0%	168	$0.00
3008F	0%	25	$0.00
3351F	0%	25	$0.00
3725F	0%	25	$0.00
1033F	0%	14	$0.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.