MOUNTAIN STATES HEALTH ALLIANCE

$3.03M

Total Medicaid Paid

52,205

Total Claims

43,215

Beneficiaries

49

Codes Billed

2018-01

First Month

2024-11

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99284		9,255	8,181	$1.49M
99283		7,723	7,197	$672K
99285		2,211	1,785	$416K
0241U		2,889	2,538	$226K
80053		5,514	4,431	$36K
85025		4,544	3,679	$25K
87651		662	626	$24K
96374		1,223	997	$20K
87804		1,375	666	$16K
99282		342	329	$15K
93005		1,512	1,066	$13K
36415		6,621	4,988	$11K
84484		985	659	$10K
80307		181	152	$7K
87880		428	410	$5K
83735		995	751	$5K
71046		303	266	$4K
96375		300	225	$4K
71045		421	326	$4K
85027		983	821	$4K
96361		229	166	$3K
87077		382	360	$2K
81001		903	758	$2K
84443		249	211	$2K
80048		257	203	$1K
70450		14	12	$1K
96372		86	77	$1K
U0003	Cov-19 amp prb hgh thruput	14	12	$830.00
80061		179	155	$804.81
83036		417	336	$714.54
Q9967	Locm 300-399mg/ml iodine,1ml	39	28	$686.40
83690		130	113	$671.49
J2405	Ondansetron hcl injection	144	122	$560.27
82043		115	97	$539.57
81025		57	52	$317.80
74018		14	12	$244.82
82570		115	97	$183.14
83880		14	13	$168.92
93306		17	14	$148.77
J1885	Ketorolac tromethamine inj	78	64	$143.04
81003		114	92	$141.44
87086		30	24	$137.29
87070		13	12	$127.94
83605		45	25	$122.16
87081		17	14	$110.83
94761		16	12	$83.16
94760		17	14	$33.84
J7030	Normal saline solution infus	18	15	$31.36
J0696	Ceftriaxone sodium injection	15	12	$14.08

Medicaid Provider Spending