PACIFIC SHORES MEDICAL GROUP, INC.

$218K

Total Medicaid Paid

18,963

Total Claims

14,314

Beneficiaries

37

Codes Billed

2018-01

First Month

2021-07

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99214		1,905	1,828	$50K
J0885	Epoetin alfa, non-esrd	346	153	$36K
J1439	Inj ferric carboxymaltos 1mg	127	106	$25K
J3490	Drugs unclassified injection	675	444	$17K
99213		1,119	1,098	$15K
96413		726	439	$15K
96372		1,558	708	$12K
96367		1,189	745	$11K
Q5106	Inj retacrit non-esrd use	117	39	$9K
99215	Prolong outpt/office vis	191	176	$6K
99232		210	72	$5K
96365		303	201	$4K
80053		1,134	1,073	$3K
99211		367	290	$3K
85025		2,431	1,621	$1K
J1626	Granisetron hcl injection	375	156	$1K
J1100	Dexamethasone sodium phos	844	541	$778.33
J1200	Diphenhydramine hcl injectio	327	200	$526.03
36592		45	34	$459.05
82608		42	42	$446.53
82728		468	466	$404.35
99223	Prolong inpt eval add15 m	13	13	$375.67
86300		115	108	$318.17
83540		597	591	$152.75
82607		76	76	$145.16
36415		1,646	1,149	$104.18
82378		448	426	$34.56
83550		596	590	$34.38
96417		15	12	$28.30
83615		447	423	$27.73
82306		54	53	$24.79
82746		134	134	$13.25
G8427	Docrev cur meds by elig clin	206	199	$12.34
83735		16	12	$12.04
84550		17	14	$4.92
84100		71	69	$0.00
99205	Prolong outpt/office vis	13	13	$0.00

Medicaid Provider Spending