BLAKE, EMILY

$527.22

Total Medicaid Paid

116

Total Claims

114

Beneficiaries

Codes Billed

2021-11

First Month

2021-11

Last Month

Year	Claims	Total Paid
2021	116	$527.22

Code	Description	Claims	Beneficiaries	Total Paid
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	34	33	$262.17
99214	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	46	45	$231.51
87880	Infectious agent antigen detection by immunoassay; Streptococcus, group A	24	24	$25.62
90460	Immunization administration through 18 years of age via any route, first or only component	12	12	$7.92

Medicaid Provider Spending