DECOURCEY, JANET

$1K

Total Medicaid Paid

50

Total Claims

49

Beneficiaries

4

Codes Billed

2018-01

First Month

2018-01

Last Month

Year	Claims	Total Paid
2018	50	$1K

Code	Description	Claims	Beneficiaries	Total Paid
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	13	12	$714.87
90460	Immunization administration through 18 years of age via any route, first or only component	13	13	$516.78
96110	Developmental screening, with scoring and documentation, per standardized instrument	12	12	$122.64
S0302	Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)	12	12	$114.00

Medicaid Provider Spending