PROVIDENCE MISSION MINISTRY LLC

$329K

Total Medicaid Paid

18,404

Total Claims

14,663

Beneficiaries

53

Codes Billed

2018-01

First Month

2024-12

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99213		4,851	3,806	$151K
99214		1,795	1,606	$70K
87635		881	791	$39K
96372		1,226	851	$15K
S8301	Infect control supplies nos	1,254	931	$15K
87804		987	473	$12K
87880		482	443	$6K
99309		621	594	$6K
99203		42	38	$2K
99408		88	80	$1K
90460		98	41	$1K
99394		13	13	$900.90
99396		12	12	$840.07
99395		12	12	$795.32
93000		76	72	$791.37
99308		251	237	$692.55
99000		73	67	$443.36
99407		33	28	$394.94
99212		14	14	$347.79
J2930	Methylprednisolone injection	65	54	$345.43
J0696	Ceftriaxone sodium injection	162	136	$274.36
0012A		27	27	$251.25
0031A		17	16	$227.12
99473		52	49	$213.79
80305		33	30	$201.02
90471		33	29	$165.42
0011A		26	24	$135.52
J1885	Ketorolac tromethamine inj	87	72	$133.41
94760		297	225	$119.66
81002		44	36	$110.65
90461		15	12	$107.27
97802		97	95	$90.88
87807		12	12	$79.20
99072		43	29	$25.00
91303		17	16	$0.20
91301		59	55	$0.20
99070		927	720	$0.00
3008F		1,024	777	$0.00
36415		196	181	$0.00
G0439	Ppps, subseq visit	12	12	$0.00
1036F		29	27	$0.00
3074F		14	13	$0.00
99318		15	15	$0.00
3725F		659	616	$0.00
G0444	Depression screen annual	53	47	$0.00
99307		31	30	$0.00
G9898	Pt 66+ snp or ltc pos > 90d	13	13	$0.00
1160F		576	407	$0.00
G8783	Bp scrn perf rec interval	16	13	$0.00
G8427	Docrev cur meds by elig clin	266	217	$0.00
1159F		650	524	$0.00
99401		13	12	$0.00
3078F		15	13	$0.00

Medicaid Provider Spending