SOUTHERN DOMINION HEALTH SYSTEM, INC.

$802K

Total Medicaid Paid

38,849

Total Claims

36,091

Beneficiaries

42

Codes Billed

2018-01

First Month

2024-12

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99214		4,851	4,553	$357K
99213		6,159	5,480	$311K
87428		507	452	$20K
87426		446	413	$12K
90686		559	536	$9K
3008F		2,850	2,713	$8K
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit	721	563	$8K
3074F		1,587	1,502	$8K
99000		3,867	3,600	$7K
1000F		2,943	2,786	$7K
3078F		1,311	1,250	$6K
3079F		970	938	$5K
36415		3,215	2,984	$5K
1034F		1,316	1,223	$4K
1036F		1,838	1,725	$4K
90677		16	16	$3K
87880		262	227	$3K
90471		716	690	$3K
4004F		761	731	$3K
99212		81	72	$3K
99394		27	27	$2K
3077F		343	334	$2K
87804		149	98	$2K
3351F		1,896	1,806	$2K
3075F		233	228	$1K
99393		15	14	$1K
0012A		35	34	$1K
83036		177	169	$1K
3017F		354	331	$725.00
99202		14	14	$709.49
0011A		39	39	$643.84
90715		22	16	$499.52
2022F		42	39	$325.00
3080F		58	57	$225.00
87807		15	13	$206.40
1035F		14	14	$150.00
81003		75	63	$147.60
99173		62	60	$132.85
99406		12	12	$64.44
90472		12	12	$34.00
91301		89	87	$0.80
1170F		190	170	$0.00

Medicaid Provider Spending