MOUNTAIN VIEW HEADACHE AND SPINE INSTITUTE PLLC

$2.28M

Total Medicaid Paid

76,157

Total Claims

25,456

Beneficiaries

45

Codes Billed

2023-01

First Month

2024-12

Last Month

Year	Claims	Total Paid
2023	24,870	$518K
2024	51,287	$1.76M

Code	Description	Claims	Beneficiaries	Total Paid
99215	Prolong outpt/office vis	4,228	1,179	$432K
99417	Prolong home eval add 15m	4,210	936	$328K
99153	Mod sedat endo service >5yrs	7,039	1,051	$253K
96365		4,339	1,248	$225K
99152		4,190	1,058	$175K
J3490	Drugs unclassified injection	6,143	1,189	$108K
96375		3,542	912	$84K
96366		4,287	1,242	$72K
93790		3,955	1,111	$57K
99214		884	757	$55K
93040		4,468	1,308	$47K
95816		145	141	$46K
99424		547	543	$37K
99457		1,142	1,096	$37K
99213		679	555	$32K
99204		381	357	$31K
99454		822	794	$27K
99425		380	377	$26K
99484		872	830	$23K
99458		859	823	$22K
95957		101	97	$22K
93923		217	207	$21K
A4930	Sterile, gloves per pair	3,036	442	$21K
36410		1,751	513	$19K
96132		158	152	$15K
J7030	Normal saline solution infus	4,758	1,312	$11K
92653		125	123	$9K
96368		508	496	$8K
95930		146	142	$8K
J3415	Pyridoxine hcl 100 mg	551	526	$6K
96139		147	139	$4K
96138		146	138	$4K
92650		92	90	$3K
A4615	Cannula nasal	2,783	872	$3K
J2405	Ondansetron hcl injection	3,900	995	$1K
99453		107	104	$1K
96136		25	25	$995.36
96137		26	26	$952.21
J0613	Calcium glucon (wg critical)	1,471	706	$870.32
J2250	Inj midazolam hydrochloride	2,213	572	$363.58
36000		106	45	$60.28
J1100	Dexamethasone sodium phos	32	12	$11.53
J1920	Inj, labetalol hcl, 5mg	22	12	$4.52
3028F		611	191	$0.41
99070		13	12	$0.00

Medicaid Provider Spending