Costa, Dary

Costa, Dary was paid $28K by Medicaid between Jan 2018 and Feb 2020, across 8 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 27% of everything it billed.

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	163	$10K
2019	221	$12K
2020	46	$6K

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	27%	131	125	$8K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	21%	139	133	$6K
69436	Tympanostomy (requiring insertion of ventilating tube), general anesthesia	18%	32	28	$5K
42820	Tonsillectomy and adenoidectomy; younger than age 12	13%	14	14	$4K
69210		8.0%	74	61	$2K
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	5.5%	15	13	$2K
31575		4.3%	12	12	$1K
99203	Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity	3.1%	13	13	$870.40

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.