WINNEBAGO TRIBE OF NEBRASKA

$2.86M

Total Medicaid Paid

12,607

Total Claims

8,672

Beneficiaries

20

Codes Billed

2018-01

First Month

2024-10

Last Month

Authorized Official	WEWEL, BETH (CHIEF FINANCIAL OFFICER)
NPI Enumeration Date	12/12/2007

Provider	City	State	Total Paid
WINNEBAGO TRIBE OF NEBRASKA	WINNEBAGO	NE	$10.23M
WINNEBAGO TRIBE OF NEBRASKA	WINNEBAGO	NE	$22K

Code	Description	Claims	Beneficiaries	Total Paid
T1015	Clinic visit/encounter, all-inclusive	7,989	4,969	$2.77M
D9999	Unspecified adjunctive procedure, by report	317	285	$94K
V2020	Frames, purchases	41	37	$683.08
92340	Fitting of spectacles, except for aphakia; monofocal	12	12	$674.48
92014	Ophthalmological services: medical examination and evaluation, comprehensive, established patient	13	13	$421.16
D1999		84	73	$350.00
D1208	Topical application of fluoride, excluding varnish	289	275	$149.98
D0140	Limited oral evaluation - problem focused	527	509	$61.34
D1206	Topical application of fluoride varnish	468	465	$10.00
D1351	Sealant - per tooth	1,062	299	$0.27
D7140	Extraction, erupted tooth or exposed root	141	105	$0.27
D0220	Intraoral - periapical first radiographic image	227	219	$0.18
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	51	39	$0.16
D0120	Periodic oral evaluation - established patient	1,018	1,012	$0.15
D0274	Bitewings - four radiographic images	77	77	$0.05
D2391	Resin-based composite - one surface, posterior, primary or permanent	21	13	$0.02
D0150	Comprehensive oral evaluation - new or established patient	41	41	$0.01
D0330	Panoramic radiographic image	83	83	$0.00
D1120	Prophylaxis - child	109	109	$0.00
D0145	Oral evaluation for a patient under three years of age	37	37	$0.00

Medicaid Provider Spending