LAKE SUPERIOR COMMUNITY HEALTH CENTER

$4.86M

Total Medicaid Paid

85,086

Total Claims

66,496

Beneficiaries

47

Codes Billed

2018-01

First Month

2022-04

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
T1015	Clinic service	20,212	16,116	$4.19M
90834		8,609	3,885	$223K
99213		6,223	4,821	$145K
99214		2,721	2,348	$72K
G0467	Fqhc visit, estab pt	1,787	1,578	$48K
90832		1,667	834	$36K
H0022	Alcohol and/or drug interven	2,711	1,228	$22K
G0470	Fqhc visit, mh estab pt	548	250	$15K
80047		1,384	1,173	$11K
G2025	Dis site tele svcs rhc/fqhc	668	236	$11K
D1110		4,333	4,109	$11K
D0140		3,658	3,267	$9K
D1206		4,334	4,020	$7K
D0274		3,734	3,496	$6K
D0120		4,247	4,029	$6K
D2392		1,597	1,246	$5K
H0005	Alcohol and/or drug services	429	164	$4K
83036		654	561	$4K
D2391		1,113	813	$4K
D7140		1,121	792	$4K
D1120		1,485	1,416	$4K
D0150		1,514	1,413	$3K
D0330		2,316	2,160	$3K
90791		72	51	$2K
90686		176	153	$2K
D0220		2,483	2,249	$2K
90658		158	141	$2K
85025		284	250	$2K
0012A		67	63	$1K
99212		56	52	$1K
D1351		620	190	$924.80
0011A		77	68	$832.00
D0272		537	508	$666.43
0002A		22	22	$616.00
D2330		74	39	$604.44
D0230		305	191	$397.20
0001A		27	27	$384.00
G0071	Comm svcs by rhc/fqhc 5 min	15	14	$64.74
36415		1,943	1,650	$26.23
90471		395	341	$2.92
Q2037	Fluvirin vacc, 3 yrs & >, im	56	52	$0.00
90460		16	15	$0.00
D2394		12	12	$0.00
D2393		177	157	$0.00
D1208		96	96	$0.00
D5899		337	185	$0.00
D2335		16	15	$0.00

Medicaid Provider Spending