Medicaid Provider SpendingClaims paid 2018–2024 · HHS public file
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1154348860

1154348860 was paid $353K by Medicaid between Jan 2018 and Apr 2020, across 312 billing codes. Its largest line is 92004, Ophthalmological services: medical examination and evaluation, comprehensive, new patient — 10% of everything it billed.

33Billing provider info1154348860
33aNPI1154348860
33bProvider type—
28Total paid$353K
24GClaims349,299
24DCodes billed312
24AFirst – last monthJan 2018 – Apr 2020
Box 24A · Dates of service

Paid by month

$0$20K$40K2018201920202021202220232024
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
YearClaimsPaid
2018162,891$125K
2019169,248$217K
202017,160$11K
Box 24 · Service lines

What it billed for

CodeServiceShareClaimsBene. recordsPaid
92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient 10% 587 586 $35K
99213 Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity 9.0% 52,976 46,178 $32K
99204 Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity 7.9% 3,304 3,236 $28K
92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient 7.3% 856 843 $26K
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 6.6% 46,912 40,840 $23K
99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes 4.8% 880 522 $17K
G0500 Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) 4.8% 435 426 $17K
G0483 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed 3.5% 41 41 $12K
J3490 Unclassified drugs 3.5% 482 475 $12K
99232 Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity 2.9% 1,806 701 $10K
99222 Initial hospital care, per day, moderate complexity 2.8% 421 385 $10K
92551 2.8% 895 893 $10K
300 more codes
99205 Prolong outpt/office vis 2.2% 429 $8K
92526 2.1% 522 $7K
99203 Doctor's office visit, new patient (routine) 1.9% 6,167 $7K
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder 1.9% 1,201 $7K
99215 Doctor's office visit, returning patient (complex) 1.7% 3,361 $6K
99233 Hospital visit by a doctor, follow-up day (complex) 1.4% 1,435 $5K
90651 1.2% 1,566 $4K
99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) 1.0% 3,486 $4K
90670 <1% 1,862 $3K
99152 <1% 209 $3K
90791 Psychiatric diagnostic evaluation <1% 14 $3K
99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) <1% 2,592 $3K
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple <1% 429 $3K
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg <1% 1,744 $2K
99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) <1% 1,914 $2K
90734 <1% 988 $2K
93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete <1% 990 $2K
99223 Prolong inpt eval add15 m <1% 768 $2K
99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward <1% 2,945 $2K
59025 Fetal non-stress test <1% 1,000 $2K
99244 Office or other outpatient consultation, moderate to high complexity <1% 955 $2K
90686 <1% 7,518 $2K
90710 <1% 634 $1K
20610 <1% 551 $1K
99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) <1% 1,661 $1K
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward <1% 4,271 $1K
45380 Colonoscopy, flexible; with biopsy, single or multiple <1% 394 $1K
90716 <1% 654 $1K
71046 Radiologic examination, chest; 2 views <1% 1,861 $1K
99395 Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years <1% 1,440 $997.64
45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) <1% 131 $961.64
99239 Hospital discharge day management, more than 30 minutes <1% 514 $948.72
90620 <1% 511 $888.86
92557 <1% 13 $858.12
17110 <1% 614 $857.80
99243 <1% 604 $833.31
99285 Emergency room visit (most serious) <1% 1,678 $745.76
99245 <1% 189 $729.72
99309 Subsequent nursing facility care, per day, low to moderate complexity <1% 40 $727.99
74177 Computed tomography, abdomen and pelvis; with contrast material <1% 729 $658.36
94060 <1% 755 $626.56
93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only <1% 2,867 $619.58
90723 <1% 1,028 $615.42
90707 <1% 649 $610.52
99385 <1% 313 $599.04
90633 <1% 1,319 $532.05
90715 <1% 1,796 $512.01
87804 Infectious agent antigen detection by immunoassay; Influenza, each type <1% 3,568 $506.87
76700 Ultrasound, abdominal, real time with image documentation; complete <1% 619 $494.62
90696 <1% 599 $486.68
99283 Emergency room visit (moderate) <1% 1,772 $482.14
93000 <1% 1,829 $441.95
92550 <1% 14 $432.88
20611 <1% 702 $428.28
77067 Screening mammography, bilateral, including computer-aided detection <1% 1,155 $426.02
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular <1% 2,964 $415.22
94726 <1% 481 $395.59
94729 <1% 458 $392.53
92002 <1% 362 $390.06
97530 Therapeutic activities, direct patient contact, each 15 minutes <1% 68 $389.90
90648 <1% 1,569 $373.04
71045 Radiologic examination, chest; single view <1% 1,874 $372.49
92012 Ophthalmological services: medical examination and evaluation, intermediate, established patient <1% 1,320 $366.87
95004 Percutaneous tests with allergenic extracts, immediate type reaction <1% 351 $354.79
76705 Ultrasound, abdominal, real time with image documentation; limited <1% 357 $346.39
76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal <1% 494 $336.90
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction <1% 971 $318.79
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A <1% 4,122 $291.42
90700 <1% 568 $284.20
69210 <1% 248 $266.09
76815 Ultrasound, pregnant uterus, real time with image documentation, limited <1% 437 $259.99
70551 Magnetic resonance imaging, brain; without contrast material <1% 87 $242.93
76942 <1% 695 $230.89
92523 <1% 12 $228.52
99308 Subsequent nursing facility care, per day, straightforward <1% 34 $224.75
83655 <1% 1,086 $223.20
95144 <1% 4,176 $218.96
74018 <1% 458 $213.38
93224 <1% 88 $206.36
76830 Ultrasound, transvaginal <1% 819 $197.26
H1003 Prenatal care, at-risk enhanced service; education <1% 2,041 $193.46
95117 <1% 3,419 $186.83
84443 Thyroid stimulating hormone (TSH) <1% 3,258 $177.11
80053 Comprehensive metabolic panel <1% 7,326 $174.96
85018 <1% 3,790 $173.16
90681 <1% 410 $169.66
73610 <1% 612 $164.69
99238 Hospital discharge day management, 30 minutes or less <1% 192 $164.30
70450 Computed tomography, head or brain; without contrast material <1% 599 $159.29
80061 Lipid panel <1% 5,715 $159.28
92083 <1% 124 $158.65
99255 <1% 13 $150.94
76536 <1% 76 $146.38
66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis <1% 245 $136.65
73080 <1% 63 $136.41
83036 Hemoglobin; glycosylated (A1C) <1% 6,362 $124.24
99284 Emergency room visit (serious) <1% 2,205 $119.61
99241 <1% 14 $117.82
73630 <1% 761 $117.54
92133 <1% 202 $112.88
76519 <1% 290 $107.58
87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe <1% 4,700 $107.54
87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe <1% 4,701 $107.19
81002 <1% 3,864 $101.02
73140 <1% 394 $100.55
73110 <1% 637 $99.52
70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences <1% 40 $98.53
73564 <1% 270 $96.95
85025 Blood count; complete (CBC), automated, and automated differential WBC count <1% 5,522 $92.83
76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete <1% 597 $92.00
20551 <1% 122 $91.86
99242 <1% 98 $90.86
73030 <1% 531 $87.92
92504 <1% 16 $87.42
11721 <1% 122 $84.12
73562 <1% 414 $81.84
69209 <1% 402 $80.80
95810 Polysomnography; sleep staging with 4 or more additional parameters <1% 105 $76.64
92134 <1% 573 $74.97
73560 <1% 253 $70.37
59425 <1% 2,497 $70.00
84439 <1% 1,603 $68.42
99221 <1% 70 $66.03
87070 <1% 1,318 $64.59
81025 <1% 1,568 $62.92
87086 Culture, bacterial; quantitative colony count, urine <1% 2,916 $62.20
J0696 Injection, ceftriaxone sodium, per 250 mg <1% 358 $58.41
72100 <1% 403 $53.01
87088 <1% 2,282 $52.90
90685 <1% 73 $52.54
99201 <1% 329 $51.01
76642 <1% 171 $50.44
82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed <1% 1,618 $42.14
73590 <1% 32 $41.56
88304 <1% 296 $41.45
J1885 Injection, ketorolac tromethamine, per 15 mg <1% 1,284 $41.43
82728 <1% 1,246 $41.04
87186 <1% 949 $39.75
86580 <1% 774 $34.77
87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies <1% 1,537 $34.44
99231 Subsequent hospital care, per day, straightforward or low complexity <1% 132 $32.48
87510 <1% 296 $31.59
87480 <1% 296 $31.55
87660 <1% 296 $31.41
64615 <1% 26 $30.41
87075 <1% 133 $29.20
73130 <1% 622 $26.84
82043 <1% 1,408 $26.17
20553 <1% 73 $25.14
82570 <1% 1,847 $24.15
83550 <1% 1,189 $23.42
86803 <1% 906 $21.37
86787 <1% 467 $19.92
82951 <1% 314 $19.72
85027 <1% 2,319 $19.70
83540 <1% 1,267 $19.44
95115 <1% 757 $17.64
20550 <1% 133 $16.74
88305 Level IV - Surgical pathology, gross and microscopic examination <1% 1,956 $14.35
81001 <1% 2,416 $14.27
87147 <1% 419 $13.68
92015 Determination of refractive state <1% 131 $13.62
93015 <1% 13 $13.43
80048 Basic metabolic panel (calcium, ionized) <1% 1,376 $12.72
87077 <1% 784 $12.39
87205 <1% 174 $11.76
83690 <1% 224 $10.34
86140 <1% 939 $8.10
86592 <1% 1,692 $6.72
85610 <1% 1,973 $5.93
J7613 Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg <1% 1,681 $4.92
85652 <1% 1,253 $4.22
99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity <1% 177 $4.18
93793 <1% 814 $2.17
86708 0% 12 $0.00
59409 Vaginal delivery only (with or without episiotomy and/or forceps) 0% 34 $0.00
A9552 Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries 0% 82 $0.00
88175 Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer 0% 1,110 $0.00
86480 0% 340 $0.00
76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation 0% 307 $0.00
80076 0% 369 $0.00
83516 0% 267 $0.00
86765 0% 12 $0.00
81003 0% 134 $0.00
99396 Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years 0% 727 $0.00
83013 0% 285 $0.00
84550 0% 327 $0.00
86038 0% 462 $0.00
20552 0% 59 $0.00
87512 0% 121 $0.00
72125 Computed tomography, cervical spine; without contrast material 0% 13 $0.00
87427 0% 160 $0.00
80307 Drug test(s), presumptive, any number of drug classes; immunoassay 0% 1,067 $0.00
86900 0% 450 $0.00
80074 0% 96 $0.00
90750 0% 37 $0.00
84156 0% 317 $0.00
G2012 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion 0% 299 $0.00
87481 0% 162 $0.00
86431 0% 218 $0.00
82274 0% 56 $0.00
90746 0% 56 $0.00
87045 0% 156 $0.00
84403 0% 281 $0.00
82652 0% 128 $0.00
87209 0% 68 $0.00
74176 Computed tomography, abdomen and pelvis; without contrast material 0% 77 $0.00
87799 0% 329 $0.00
99401 0% 248 $0.00
76770 0% 27 $0.00
85014 0% 42 $0.00
84702 0% 193 $0.00
84450 0% 14 $0.00
73721 Magnetic resonance imaging, any joint of lower extremity; without contrast material 0% 25 $0.00
11750 0% 14 $0.00
85007 0% 65 $0.00
83970 0% 95 $0.00
85048 0% 53 $0.00
87177 0% 68 $0.00
J0585 Injection, onabotulinumtoxina, 1 unit 0% 21 $0.00
86200 0% 12 $0.00
78815 Positron emission tomography (PET) for limited area imaging 0% 25 $0.00
84146 0% 64 $0.00
J7307 Etonogestrel (contraceptive) implant system, including implant and supplies 0% 14 $0.00
84481 0% 44 $0.00
86003 0% 13 $0.00
90653 0% 22 $0.00
84460 0% 27 $0.00
76813 0% 13 $0.00
90662 0% 31 $0.00
86735 0% 12 $0.00
J2405 Injection, ondansetron hydrochloride, per 1 mg 0% 13 $0.00
72141 0% 12 $0.00
93325 0% 14 $0.00
10060 0% 13 $0.00
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 0% 5,559 $0.00
82962 0% 406 $0.00
84153 0% 263 $0.00
82607 0% 906 $0.00
88142 0% 717 $0.00
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg 0% 352 $0.00
82784 0% 242 $0.00
87046 0% 158 $0.00
86317 0% 39 $0.00
86850 0% 421 $0.00
87340 0% 852 $0.00
87522 Neg quan hep c or qual rna 0% 75 $0.00
88307 0% 58 $0.00
87081 0% 1,277 $0.00
80069 0% 170 $0.00
93016 0% 15 $0.00
88141 0% 55 $0.00
87661 Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe 0% 350 $0.00
86901 0% 472 $0.00
87624 Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types 0% 1,152 $0.00
J1100 Injection, dexamethasone sodium phosphate, 1 mg 0% 26 $0.00
86762 0% 569 $0.00
92250 0% 37 $0.00
85730 0% 225 $0.00
82746 0% 512 $0.00
83014 0% 186 $0.00
86800 0% 13 $0.00
00142 0% 212 $0.00
62326 0% 48 $0.00
99070 0% 118 $0.00
H1001 Prenatal care, at-risk enhanced service; antepartum management 0% 157 $0.00
99383 0% 73 $0.00
11200 0% 24 $0.00
58300 0% 214 $0.00
83001 0% 167 $0.00
83735 0% 168 $0.00
J7298 Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg 0% 37 $0.00
58100 0% 16 $0.00
H2000 Comprehensive multidisciplinary evaluation 0% 67 $0.00
58301 0% 28 $0.00
99406 0% 39 $0.00
72040 0% 74 $0.00
83002 0% 42 $0.00
17000 0% 13 $0.00
88342 0% 45 $0.00
93971 0% 12 $0.00
87521 Neg quan hep c or qual rna 0% 28 $0.00
76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up 0% 66 $0.00
72148 Magnetic resonance imaging, lumbar spine; without contrast material 0% 25 $0.00
95012 0% 53 $0.00
82378 0% 13 $0.00
73502 0% 65 $0.00
93018 0% 16 $0.00
G0008 Administration of influenza virus vaccine 0% 48 $0.00
86376 0% 69 $0.00
90674 0% 32 $0.00
59430 0% 107 $0.00
71260 Computed tomography, thorax, diagnostic; with contrast material 0% 12 $0.00
70486 0% 12 $0.00
81000 0% 16 $0.00
99384 0% 32 $0.00
86704 0% 12 $0.00
84402 0% 15 $0.00
59514 0% 24 $0.00
82550 0% 13 $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.