RIVERTON MEMORIAL HOSPITAL LLC

$4.65M

Total Medicaid Paid

85,609

Total Claims

68,030

Beneficiaries

47

Codes Billed

2018-01

First Month

2024-11

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99283		18,286	16,699	$1.89M
99284		12,101	9,993	$1.63M
41899		714	688	$849K
96374		3,169	2,334	$189K
96361		964	668	$23K
87635		646	463	$16K
99285		188	118	$15K
71045		781	506	$14K
96375		506	320	$7K
99282		112	111	$7K
U0001	2019-ncov diagnostic p	294	230	$3K
96365		43	27	$2K
99281		41	41	$2K
71046		55	54	$1K
80307		630	489	$1K
70450		28	24	$1K
C9803	Hopd covid-19 spec collect	859	591	$1K
96360		23	14	$1K
80053		14,190	10,748	$806.98
85025		17,048	12,898	$581.61
36415		89	86	$185.41
86140		315	17	$12.70
85379		330	29	$9.00
81001		2,902	2,406	$6.32
87400		234	160	$0.00
J7030	Normal saline solution infus	691	540	$0.00
J2405	Ondansetron hcl injection	1,066	898	$0.00
J7120	Ringers lactate infusion	488	450	$0.00
93005		660	434	$0.00
87420		87	83	$0.00
87804		1,185	552	$0.00
85610		157	121	$0.00
Q9967	Locm 300-399mg/ml iodine,1ml	14	13	$0.00
J1885	Ketorolac tromethamine inj	171	160	$0.00
83735		1,606	1,158	$0.00
82150		123	83	$0.00
80048		227	162	$0.00
J1100	Dexamethasone sodium phos	427	407	$0.00
83690		2,539	1,896	$0.00
J2704	Inj, propofol, 10 mg	577	553	$0.00
85730		124	94	$0.00
96372		99	94	$0.00
J3010	Fentanyl citrate injection	373	350	$0.00
84703		30	24	$0.00
84484		312	154	$0.00
Q0162	Ondansetron oral	76	64	$0.00
87430		29	26	$0.00

Medicaid Provider Spending