NPI: 1275626053 · WAHPETON, ND 58075 · 251K00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 124 | $5K |
| 2019 | 124 | $5K |
| 2020 | 86 | $844.62 |
| 2021 | 55 | $1K |
| 2022 | 26 | $950.63 |
| 2023 | 158 | $5K |
| 2024 | 166 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| S0302 | Completed epsdt | 57 | 57 | $7K |
| 91322 | 78 | 75 | $6K | |
| 90471 | 246 | 239 | $4K | |
| 90682 | 32 | 30 | $2K | |
| 90480 | 79 | 76 | $717.93 | |
| 0064A | 16 | 12 | $676.48 | |
| 90673 | 25 | 22 | $412.82 | |
| 90686 | 97 | 92 | $385.18 | |
| 90688 | 15 | 15 | $142.72 | |
| 90656 | 16 | 16 | $132.37 | |
| 90472 | 13 | 12 | $49.68 | |
| 91306 | 16 | 12 | $0.00 | |
| G0008 | Admin influenza virus vac | 49 | 46 | $0.00 |