DELOLLIS, RITA

$10K

Total Medicaid Paid

454

Total Claims

420

Beneficiaries

5

Codes Billed

2018-05

First Month

2022-04

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
90460	Immunization administration through 18 years of age via any route, first or only component	188	158	$5K
99215	Prolong outpt/office vis	14	12	$2K
S0302	Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)	189	188	$2K
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	13	12	$744.38
96127		50	50	$513.50

Medicaid Provider Spending