RAMIREZ, JACLYN

$31K

Total Medicaid Paid

649

Total Claims

629

Beneficiaries

4

Codes Billed

2018-01

First Month

2018-12

Last Month

Year	Claims	Total Paid
2018	649	$31K

Code	Description	Claims	Beneficiaries	Total Paid
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	339	321	$17K
S0395	Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic	177	177	$10K
99212	Office or other outpatient visit for the evaluation and management of an established patient, straightforward	120	118	$3K
99203	Office or other outpatient visit for the evaluation and management of a new patient, low complexity	13	13	$885.17

Medicaid Provider Spending