EVN DIALYSIS CENTER, LLC

$923K

Total Medicaid Paid

22,154

Total Claims

4,928

Beneficiaries

24

Codes Billed

2022-02

First Month

2024-11

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
90999		6,898	710	$630K
Q4081	Epoetin alfa, 100 units esrd	1,688	286	$71K
Q5105	Inj retacrit esrd on dialysi	942	230	$70K
0821		499	101	$60K
J1756	Iron sucrose injection	1,672	544	$48K
J0887	Epoetin beta esrd use	215	146	$24K
A4657	Syringe w/wo needle	2,496	436	$10K
J1644	Inj heparin sodium per 1000u	4,517	275	$9K
80051		139	138	$485.72
83970		105	103	$127.15
84466		154	152	$59.39
84520		324	156	$42.00
82728		92	90	$35.85
82310		182	153	$34.31
A4913	Misc dialysis supplies noc	1,010	364	$32.78
83540		158	153	$30.84
84100		221	154	$29.93
82565		153	152	$23.27
82040		178	153	$21.69
85045		153	152	$19.15
87340		60	59	$18.06
84155		152	151	$15.96
83735		58	58	$11.80
0250		88	12	$0.00

Medicaid Provider Spending