LIBERTY DIALYSIS PETERSBURG, LLC

$4.25M

Total Medicaid Paid

232,537

Total Claims

60,711

Beneficiaries

46

Codes Billed

2018-01

First Month

2024-10

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
90999		51,009	3,961	$2.92M
J0887	Epoetin beta esrd use	5,820	3,021	$819K
90935		3,767	408	$418K
J1756	Iron sucrose injection	12,130	2,430	$35K
A4657	Syringe w/wo needle	56,351	3,250	$34K
J0604	Cinacalcet, esrd on dialysis	6,273	715	$9K
J3490	Drugs unclassified injection	1,357	268	$2K
J1644	Inj heparin sodium per 1000u	28,692	966	$2K
83970		2,354	2,015	$926.07
85025		3,849	3,348	$350.39
84520		8,674	3,305	$326.62
G0009	Admin pneumococcal vaccine	16	12	$272.95
83540		3,958	3,478	$272.91
G0008	Admin influenza virus vac	237	216	$258.30
82310		4,240	2,934	$244.03
84100		4,391	2,985	$240.82
85018		8,388	3,300	$238.54
82728		1,721	1,518	$238.02
90740		16	12	$230.89
80051		3,142	2,718	$216.05
84466		1,830	1,606	$214.77
J1270	Injection, doxercalciferol	3,363	300	$204.92
83550		2,015	1,763	$196.21
87340		1,533	1,263	$195.91
82040		3,476	2,879	$193.09
82565		3,244	2,810	$190.66
84075		2,593	2,291	$121.28
84450		1,732	1,512	$90.33
84155		2,034	1,778	$67.81
84460		1,861	1,651	$45.13
90662		79	71	$40.74
83735		665	581	$32.30
86704		101	91	$28.52
86706		302	254	$25.64
90686		46	44	$23.64
82108		223	198	$23.06
82746		126	118	$21.84
80069		431	408	$21.20
84132		72	51	$7.97
90688		67	60	$2.75
82607		22	20	$1.96
A4913	Misc dialysis supplies noc	277	49	$1.03
0064A		14	14	$0.00
G0010	Admin hepatitis b vaccine	16	12	$0.00
82947		13	13	$0.00
90682		17	14	$0.00

Medicaid Provider Spending