GARRISON, ETOI

$51K

Total Medicaid Paid

1,231

Total Claims

1,032

Beneficiaries

6

Codes Billed

2020-04

First Month

2020-12

Last Month

Year	Claims	Total Paid
2020	1,231	$51K

Code	Description	Claims	Beneficiaries	Total Paid
76816	Ultrasound, pregnant uterus, real time with image documentation, follow-up	507	474	$21K
76819	Fetal biophysical profile; without non-stress testing	454	319	$17K
76805	Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation	210	199	$11K
99215	Prolong outpt/office vis	26	13	$1K
99214	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	20	13	$875.44
76815	Ultrasound, pregnant uterus, real time with image documentation, limited	14	14	$524.60

Medicaid Provider Spending