PACIFICA OF THE VALLEY CORPORATION

$987K

Total Medicaid Paid

73,101

Total Claims

66,886

Beneficiaries

71

Codes Billed

2018-01

First Month

2024-11

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
0450		10,658	9,816	$357K
70450		911	881	$93K
74176		377	365	$40K
74150		376	360	$37K
96374		719	694	$36K
93005		1,637	1,515	$34K
80053		4,976	4,672	$31K
G0480	Drug test def 1-7 classes	1,188	1,108	$29K
99281		551	511	$28K
85025		5,344	4,959	$23K
76700		360	354	$21K
87635		978	941	$19K
96360		385	374	$18K
82553		2,029	1,917	$18K
72192		298	289	$17K
84484		2,435	2,058	$15K
94760		1,975	1,876	$14K
71046		881	845	$13K
96372		801	778	$13K
80305		1,590	1,515	$10K
71045		948	913	$9K
82150		2,652	2,506	$9K
99199		1,838	1,578	$9K
J7030	Normal saline solution infus	1,636	865	$9K
85730		2,634	2,516	$9K
83880		516	481	$8K
83690		2,072	1,979	$8K
81001		4,253	4,046	$8K
J3490	Drugs unclassified injection	1,838	1,231	$8K
82550		2,021	1,914	$7K
85610		2,669	2,550	$6K
81025		1,588	1,484	$5K
96375		101	98	$3K
99282		82	80	$2K
J1885	Ketorolac tromethamine inj	606	572	$2K
94060		69	67	$2K
87086		382	363	$2K
0270		830	616	$2K
0301		81	79	$2K
99284		114	112	$1K
85007		549	529	$1K
76856		27	27	$1K
99283		71	68	$947.02
96365		12	12	$864.60
87040		69	67	$846.63
0259		1,187	938	$842.11
87400		175	166	$832.57
80048		195	189	$807.78
J2405	Ondansetron hcl injection	213	195	$773.74
99285		75	75	$460.44
73564		15	15	$320.50
85378		67	64	$320.10
94640		16	15	$307.98
82948		117	103	$307.07
96370		21	21	$296.20
73610		13	13	$193.28
84443		30	30	$153.53
73130		12	12	$142.80
86756		14	14	$134.72
84703		44	43	$130.05
0250		189	144	$129.24
99001		1,408	1,312	$128.43
36415		2,704	2,495	$93.71
96376		14	13	$48.51
J0696	Ceftriaxone sodium injection	14	14	$41.04
J2270	Morphine sulfate injection	12	12	$34.86
J2001	Lidocaine injection	12	12	$30.40
80371		30	30	$18.53
J7131	Hypertonic saline sol	12	12	$0.41
80320		370	356	$0.00
0272		15	12	$0.00

Medicaid Provider Spending