STC PEDIATRICS LLC

$997K

Total Medicaid Paid

26,530

Total Claims

25,048

Beneficiaries

47

Codes Billed

2020-10

First Month

2024-12

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99214		4,077	3,845	$268K
99215	Prolong outpt/office vis	2,216	2,116	$213K
99392		1,542	1,501	$157K
99391		813	788	$86K
99213		1,327	1,258	$64K
99393		511	495	$46K
G0179	Md recertification hha pt	1,343	1,312	$42K
90460		1,558	1,413	$24K
96110		1,965	1,835	$19K
99394		204	200	$18K
99188		795	750	$14K
94664		684	645	$11K
92551		1,005	973	$10K
90686		1,489	1,373	$6K
99173		766	740	$4K
96372		215	194	$3K
99381		31	29	$3K
96161		421	387	$2K
90648		615	589	$1K
90658		232	232	$1K
90670		530	503	$1K
87807		26	25	$354.28
90633		212	195	$336.75
90677		102	102	$328.75
87804		26	25	$310.58
90723		293	280	$301.48
90680		283	267	$290.00
90461		273	248	$234.77
G2211	Complex e/m visit add on	15	15	$186.43
90480		12	12	$150.25
96380		17	17	$143.39
91319		13	13	$141.75
90651		65	55	$127.00
S9470	Nutritional counseling, diet	88	74	$89.80
90381		21	21	$80.00
G9919	Scrn nd pos nd prov of rec	2,193	2,001	$0.00
G9920	Scrning perf and negative	268	259	$0.00
90700		13	13	$0.00
J7510	Prednisolone oral per 5 mg	12	12	$0.00
90710		15	15	$0.00
J7611	Albuterol non-comp con	130	117	$0.00
94640		17	15	$0.00
J7644	Ipratropium bromide non-comp	41	36	$0.00
90696		15	15	$0.00
J1100	Dexamethasone sodium phos	13	13	$0.00
99496		15	12	$0.00
90620		13	13	$0.00

Medicaid Provider Spending