MISSOULA COMMUNITY HEALTH SERVICES, INC.

$140K

Total Medicaid Paid

25,871

Total Claims

18,935

Beneficiaries

44

Codes Billed

2018-01

First Month

2024-12

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99214		908	582	$39K
99283		2,724	2,062	$38K
99284		1,026	766	$13K
99282		1,021	850	$8K
99213		477	273	$8K
G0463	Hospital outpt clinic visit	46	43	$6K
80053		3,463	2,699	$5K
96361		81	61	$4K
87635		1,495	1,254	$4K
99285		66	56	$3K
85025		3,515	2,634	$2K
87400		264	191	$2K
J3490	Drugs unclassified injection	1,826	755	$1K
93005		397	298	$1K
97110		160	37	$1K
36415		4,357	3,286	$919.03
J7030	Normal saline solution infus	166	126	$475.11
80061		307	264	$426.02
J8499	Oral prescrip drug non chemo	159	121	$388.47
86140		355	280	$335.43
96374		322	260	$292.55
U0003	Cov-19 amp prb hgh thruput	19	17	$232.49
96375		66	57	$209.13
71045		59	51	$181.92
71046		49	40	$169.87
80048		68	53	$131.99
81001		263	222	$117.23
83690		47	39	$113.80
84443		679	568	$105.24
83036		67	63	$87.87
81003		347	296	$59.52
84484		74	62	$57.10
96360		128	83	$55.17
90471		34	34	$40.19
90688		20	19	$16.20
80305		19	12	$6.97
85027		67	59	$6.70
J2405	Ondansetron hcl injection	18	18	$0.22
G0480	Drug test def 1-7 classes	18	13	$0.00
87651		26	24	$0.00
81015		60	38	$0.00
A9270	Non-covered item or service	557	233	$0.00
87086		12	12	$0.00
J7040	Normal saline solution infus	39	24	$0.00

Medicaid Provider Spending