NPI: 1821205188 · IDAHO FALLS, ID 83401 · 251K00000X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 4,615 | $58K |
| 2019 | 4,554 | $57K |
| 2020 | 4,461 | $61K |
| 2021 | 14,536 | $237K |
| 2022 | 5,247 | $71K |
| 2023 | 3,282 | $73K |
| 2024 | 2,299 | $64K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 90471 | 8,235 | 8,091 | $147K | |
| 90472 | 3,891 | 3,842 | $87K | |
| 0002A | 1,900 | 1,898 | $73K | |
| 0001A | 2,005 | 2,000 | $65K | |
| 90651 | 1,389 | 1,377 | $40K | |
| T1017 | Targeted case management | 151 | 97 | $38K |
| 90715 | 1,717 | 1,705 | $15K | |
| 91320 | 119 | 119 | $13K | |
| 99211 | 679 | 673 | $12K | |
| 0004A | 311 | 310 | $12K | |
| J1050 | Medroxyprogesterone acetate | 778 | 774 | $11K |
| 90686 | 2,532 | 2,526 | $11K | |
| 90620 | 552 | 549 | $11K | |
| 90473 | 441 | 441 | $8K | |
| 0072A | 195 | 195 | $8K | |
| 0012A | 289 | 289 | $7K | |
| 0124A | 193 | 193 | $7K | |
| 0071A | 204 | 204 | $7K | |
| 90480 | 207 | 207 | $7K | |
| 0064A | 133 | 132 | $5K | |
| 90734 | 960 | 952 | $5K | |
| 0011A | 335 | 335 | $5K | |
| 0031A | 136 | 136 | $5K | |
| 0054A | 88 | 88 | $3K | |
| 90688 | 184 | 184 | $3K | |
| 90739 | 14 | 14 | $2K | |
| 0134A | 47 | 47 | $2K | |
| 0003A | 42 | 42 | $2K | |
| 90619 | 250 | 250 | $1K | |
| 99203 | 14 | 14 | $1K | |
| 90707 | 53 | 52 | $1K | |
| 90716 | 57 | 55 | $1K | |
| 90656 | 148 | 148 | $1K | |
| 96372 | 112 | 110 | $1K | |
| 90636 | 12 | 12 | $1K | |
| 90672 | 518 | 515 | $672.35 | |
| 90474 | 48 | 48 | $543.60 | |
| 90670 | 221 | 219 | $520.11 | |
| 36415 | 39 | 39 | $135.20 | |
| 87491 | 946 | 784 | $81.48 | |
| 87591 | 946 | 784 | $81.48 | |
| 87661 | 891 | 783 | $51.00 | |
| 90633 | 305 | 302 | $25.00 | |
| 90710 | 160 | 158 | $0.00 | |
| 91300 | 4,288 | 3,815 | $0.00 | |
| 86703 | 25 | 25 | $0.00 | |
| 91312 | 193 | 193 | $0.00 | |
| 91313 | 50 | 49 | $0.00 | |
| A4267 | Male condom | 13 | 13 | $0.00 |
| 86780 | 51 | 50 | $0.00 | |
| 91306 | 132 | 131 | $0.00 | |
| 91301 | 694 | 684 | $0.00 | |
| 90680 | 12 | 12 | $0.00 | |
| 91305 | 155 | 153 | $0.00 | |
| 90723 | 98 | 97 | $0.00 | |
| 91307 | 459 | 397 | $0.00 | |
| 90696 | 116 | 116 | $0.00 | |
| 91303 | 149 | 149 | $0.00 | |
| 90647 | 100 | 99 | $0.00 | |
| 86803 | 12 | 12 | $0.00 |