QUALICENTERS INLAND NORTHWEST L.L.C.

$5.12M

Total Medicaid Paid

167,034

Total Claims

44,794

Beneficiaries

43

Codes Billed

2018-01

First Month

2024-11

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
90999		61,644	3,732	$3.97M
J0887	Epoetin beta esrd use	4,103	2,618	$516K
A4657	Syringe w/wo needle	37,888	2,690	$479K
83970		2,403	2,081	$54K
J1756	Iron sucrose injection	7,171	1,846	$33K
82040		2,947	2,384	$24K
84100		3,323	2,416	$12K
84520		5,186	2,420	$7K
83550		2,795	2,530	$6K
82565		2,535	2,269	$6K
84132		4,587	1,998	$6K
85018		6,700	2,189	$4K
84075		812	754	$3K
82310		3,570	2,375	$2K
83540		2,884	2,608	$2K
83735		835	767	$1K
J1270	Injection, doxercalciferol	2,437	238	$645.61
82728		950	873	$618.11
90686		65	57	$451.57
85025		414	384	$444.90
82374		2,117	1,866	$441.79
84295		1,993	1,766	$430.86
90732		19	18	$342.63
82108		206	192	$286.95
85027		946	854	$284.63
90661		18	18	$73.70
82746		119	111	$67.79
82607		117	108	$55.80
80069		33	28	$55.30
83036		58	51	$37.13
82947		313	284	$18.62
G0307	Cbc without platelet	912	804	$0.00
J3490	Drugs unclassified injection	2,068	247	$0.00
86706		205	190	$0.00
87340		613	537	$0.00
80051		44	40	$0.00
G0008	Admin influenza virus vac	197	184	$0.00
86803		32	32	$0.00
90688		45	42	$0.00
G0009	Admin pneumococcal vaccine	19	18	$0.00
J1644	Inj heparin sodium per 1000u	3,670	137	$0.00
90662		13	12	$0.00
90682		28	26	$0.00

Medicaid Provider Spending