GREAT FALLS DIALYSIS LLC

$4.38M

Total Medicaid Paid

98,303

Total Claims

23,142

Beneficiaries

43

Codes Billed

2018-01

First Month

2024-10

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
90999		37,748	2,984	$3.79M
J1756	Iron sucrose injection	3,795	782	$77K
J1644	Inj heparin sodium per 1000u	2,555	239	$58K
A4657	Syringe w/wo needle	5,982	1,588	$51K
84100		2,281	1,391	$45K
84520		2,059	1,312	$44K
83970		786	691	$39K
83540		1,591	1,382	$39K
83550		988	891	$39K
80053		983	884	$37K
J0887	Epoetin beta esrd use	1,912	1,016	$34K
82728		1,288	1,128	$30K
J0606	Inj, etelcalcetide, 0.1 mg	1,209	112	$26K
J2916	Na ferric gluconate complex	144	47	$20K
84132		253	110	$16K
82306		150	135	$11K
J0882	Darbepoetin alfa, esrd use	58	23	$7K
87340		677	560	$6K
82108		119	109	$6K
86706		162	137	$6K
86803		15	15	$517.80
82310		819	490	$250.72
85025		590	486	$169.90
82565		611	490	$151.90
84450		597	486	$151.73
84466		603	489	$136.40
85014		486	392	$121.14
OP250		25,142	1,525	$76.05
90686		108	76	$75.46
85018		936	422	$60.94
80051		521	419	$56.79
90732		16	12	$53.38
84075		605	487	$52.37
82040		859	500	$41.49
83615		598	490	$41.14
84155		605	487	$20.94
G0008	Admin influenza virus vac	126	94	$5.02
82374		84	67	$0.00
84295		84	67	$0.00
0003A		19	14	$0.00
82435		84	67	$0.00
G0009	Admin pneumococcal vaccine	36	30	$0.00
86704		19	16	$0.00

Medicaid Provider Spending