PUEBLO COMMUNITY HEALTH CENTER INC.

$5.99M

Total Medicaid Paid

66,306

Total Claims

60,611

Beneficiaries

45

Codes Billed

2018-01

First Month

2022-01

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99214		16,299	14,917	$2.82M
99213		13,844	12,632	$2.51M
99212		2,014	1,882	$371K
90834		1,496	1,047	$164K
G0467	Fqhc visit, estab pt	2,582	2,350	$29K
99215	Prolong outpt/office vis	141	129	$25K
90471		5,951	5,743	$11K
99202		69	63	$11K
99203		42	41	$8K
99393		36	36	$8K
99396		39	37	$6K
G2025	Dis site tele svcs rhc/fqhc	278	215	$4K
90832		26	22	$3K
0012A		80	78	$3K
0011A		87	84	$3K
99395		12	12	$3K
99204		14	13	$3K
99211		14	14	$2K
G8510	Scr dep neg, no plan reqd	11,913	10,936	$2K
99407		2,464	1,972	$2K
0003A		56	30	$988.32
90750		51	49	$511.93
90688		1,297	1,275	$447.06
G8511	Scr dep pos, no plan doc rng	452	428	$445.06
83036		410	393	$24.59
96372		834	759	$0.00
99406		756	687	$0.00
82962		365	341	$0.00
3008F		791	737	$0.00
G0008	Admin influenza virus vac	168	163	$0.00
90686		260	252	$0.00
J1885	Ketorolac tromethamine inj	86	82	$0.00
90651		14	14	$0.00
90472		960	917	$0.00
G8431	Pos clin depres scrn f/u doc	122	109	$0.00
87880		52	51	$0.00
90682		1,301	1,243	$0.00
G0444	Depression screen annual	351	301	$0.00
81003		452	433	$0.00
99173		60	59	$0.00
90670		12	12	$0.00
87804		14	13	$0.00
J1050	Medroxyprogesterone acetate	14	14	$0.00
90715		14	14	$0.00
81025		13	12	$0.00

Medicaid Provider Spending