DSI APPLE VALLEY HOME DIALYSIS, LLC

$3.73M

Total Medicaid Paid

115,949

Total Claims

43,713

Beneficiaries

45

Codes Billed

2021-03

First Month

2024-10

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
90999		17,218	1,532	$2.15M
90945		27,806	975	$1.57M
G0491	Dialysis acu kidney no esrd	104	12	$2K
J1756	Iron sucrose injection	3,733	1,487	$2K
J0604	Cinacalcet, esrd on dialysis	73	63	$1K
84075		2,500	2,385	$898.71
J0887	Epoetin beta esrd use	1,670	1,058	$684.72
Q4081	Epoetin alfa, 100 units esrd	3,466	464	$642.60
90747		38	38	$278.68
J3490	Drugs unclassified injection	12	12	$219.32
83970		1,265	1,192	$45.82
84466		2,540	2,379	$36.50
G0010	Admin hepatitis b vaccine	49	49	$33.36
87340		1,405	1,357	$30.21
84520		5,222	2,280	$27.18
84450		1,117	1,104	$26.46
85025		2,464	2,373	$22.38
80051		2,196	2,144	$20.67
83540		2,540	2,378	$18.95
82565		2,516	2,271	$17.24
84100		3,232	2,314	$13.95
82728		824	800	$13.85
82310		2,585	2,376	$12.30
82040		2,499	2,249	$12.06
84155		2,396	2,341	$8.88
85018		1,947	1,457	$4.49
85014		1,227	1,100	$4.22
90674		42	41	$0.00
A4657	Syringe w/wo needle	15,667	2,066	$0.00
0250		147	120	$0.00
83735		1,137	1,109	$0.00
82607		176	172	$0.00
84132		217	179	$0.00
82306		296	286	$0.00
82435		152	147	$0.00
82746		174	170	$0.00
86706		181	178	$0.00
G0008	Admin influenza virus vac	97	96	$0.00
J1644	Inj heparin sodium per 1000u	4,189	378	$0.00
82570		249	131	$0.00
82108		107	103	$0.00
84295		153	147	$0.00
J2405	Ondansetron hcl injection	153	37	$0.00
82374		152	147	$0.00
90661		16	16	$0.00

Medicaid Provider Spending