LI, SIMON

$1.97M

Total Medicaid Paid

125,185

Total Claims

93,416

Beneficiaries

64

Codes Billed

2018-10

First Month

2024-12

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99213		33,203	19,910	$1.71M
99203		666	663	$65K
99212		1,262	1,170	$48K
99396		213	213	$26K
99051		3,859	3,310	$18K
90471		1,213	1,188	$15K
93000		1,494	1,484	$13K
G0108	Diab manage trn per indiv	803	744	$9K
3078F		11,463	7,261	$9K
3074F		8,982	5,696	$9K
96372		1,797	1,566	$7K
90688		1,493	1,493	$7K
81000		2,800	2,771	$5K
G0444	Depression screen annual	1,199	1,184	$4K
36415		3,530	3,503	$3K
36410		1,939	1,907	$3K
0064A		164	164	$3K
90674		203	201	$2K
3079F		3,162	2,232	$2K
3075F		3,693	2,669	$2K
99397		1,166	1,161	$2K
96127		900	887	$2K
3077F		2,590	1,790	$1K
90658		202	202	$1K
G8510	Scr dep neg, no plan reqd	896	887	$958.50
99214		17	17	$694.76
99490	Ccm add 20min	249	246	$640.90
0124A		50	50	$571.89
J3420	Vitamin b12 injection	1,630	1,431	$464.91
90686		73	73	$464.80
99072		1,587	1,258	$396.00
90756		19	19	$385.26
3080F		406	316	$372.50
1159F		10,872	7,673	$338.41
1160F		10,873	7,674	$335.31
0134A		50	50	$326.07
99497		17	17	$234.64
83036		121	120	$186.92
90460		46	46	$71.54
3044F		651	649	$60.00
81002		39	38	$50.90
3051F		51	51	$40.00
G0008	Admin influenza virus vac	1,101	1,101	$32.23
99000		609	579	$30.12
82043		157	156	$16.83
G9622	No unheal etoh user	475	475	$6.00
G9275	Doc of non tobacco user	448	448	$6.00
3016F		536	536	$0.00
3725F		669	661	$0.00
91312		49	49	$0.00
91313		48	48	$0.00
0013A		16	16	$0.00
G8420	Calc bmi norm parameters	1,810	1,779	$0.00
1000F		551	551	$0.00
3008F		1,822	1,791	$0.00
97802		168	164	$0.00
1170F		114	112	$0.00
H0001	Alcohol and/or drug assess	143	143	$0.00
1036F		504	504	$0.00
91306		128	128	$0.00
1125F		133	130	$0.00
91301		17	17	$0.00
G0439	Ppps, subseq visit	28	28	$0.00
90694		16	16	$0.00

Medicaid Provider Spending