1689777435

1689777435 was paid $9K by Medicaid between Jun 2019 and May 2021, across 6 billing codes. Its largest line is 90715, — 41% of everything it billed.

33Billing provider info1689777435

33aNPI1689777435

33bProvider type—

28Total paid$9K

24GClaims548

24DCodes billed6

24AFirst – last monthJun 2019 – May 2021

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
2019	330	$6K
2020	205	$3K
2021	13	$0.00

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
90715		41%	117	113	$4K
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	30%	286	217	$3K
90732		15%	12	12	$1K
90686		14%	104	88	$1K
90471CG		0%	16	16	$0.00
91301		0%	13	13	$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.