ST. RAPHAEL DIALYSIS CENTER PARTNERSHIP

$3.30M

Total Medicaid Paid

252,763

Total Claims

67,024

Beneficiaries

40

Codes Billed

2018-01

First Month

2024-11

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
90999		77,215	5,669	$1.18M
A4657	Syringe w/wo needle	53,576	4,003	$1.16M
80069		2,690	2,310	$408K
80051		1,777	1,468	$93K
82040		1,922	1,616	$84K
82310		3,053	1,919	$63K
J3490	Drugs unclassified injection	2,143	147	$58K
Q4081	Epoetin alfa, 100 units esrd	1,056	114	$44K
J0887	Epoetin beta esrd use	6,730	3,360	$43K
82565		2,275	1,745	$36K
J1756	Iron sucrose injection	18,195	3,952	$24K
85018		14,499	3,976	$23K
83540		4,754	4,063	$17K
82108		437	362	$14K
83970		4,908	4,049	$13K
83550		4,729	4,038	$8K
82728		2,714	2,263	$7K
84520		8,727	4,101	$4K
84132		1,144	350	$4K
J0604	Cinacalcet, esrd on dialysis	4,994	987	$3K
87340		2,407	2,017	$2K
84155		4,495	3,852	$2K
84075		1,393	1,180	$601.08
83735		1,357	1,145	$559.46
85025		4,646	3,954	$467.10
84100		2,501	1,877	$463.97
86706		1,105	955	$267.22
90686		64	48	$233.44
J1644	Inj heparin sodium per 1000u	15,071	420	$1.20
90688		46	46	$0.00
83036		98	55	$0.00
J1270	Injection, doxercalciferol	929	74	$0.00
86803		173	130	$0.00
G0008	Admin influenza virus vac	233	196	$0.00
82746		345	283	$0.00
G0010	Admin hepatitis b vaccine	144	119	$0.00
90739		33	26	$0.00
90740		111	93	$0.00
90662		57	45	$0.00
90661		17	17	$0.00

Medicaid Provider Spending