DECLUE, TERRY

$65K

Total Medicaid Paid

1,171

Total Claims

1,153

Beneficiaries

5

Codes Billed

2019-01

First Month

2020-02

Last Month

Year	Claims	Total Paid
2019	1,146	$62K
2020	25	$2K

Code	Description	Claims	Beneficiaries	Total Paid
99214	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	498	493	$51K
99204	Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	48	44	$8K
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	60	60	$4K
83036	Hemoglobin; glycosylated (A1C)	279	274	$1K
82947		286	282	$446.37

Medicaid Provider Spending