Costa, Katharine

Costa, Katharine was paid $33K by Medicaid between Feb 2020 and Nov 2021, across 13 billing codes. Its largest line is 99394, Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) — 30% of everything it billed.

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2020	103	$3K
2021	899	$30K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99394	Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years)	30%	113	104	$10K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	27%	153	142	$9K
99393	Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years)	20%	83	78	$7K
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	8.9%	267	252	$3K
90472	Immunization administration, each additional vaccine (list separately)	5.2%	148	98	$2K
99212	Office or other outpatient visit for the evaluation and management of an established patient, straightforward	3.5%	27	27	$1K
99392	Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years)	3.4%	15	13	$1K
96127		1.7%	125	115	$576.72
87430		<1%	14	14	$236.74
87081		<1%	17	17	$164.34
3008F		0%	13	13	$0.00
1160F		0%	13	12	$0.00

1 more codes

4004F

0%

14

$0.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.