The HHS Medicaid provider spending dataset covers $1.09 trillion in claims across 10,881 distinct billing codes. But spending is heavily concentrated at the top — the 25 most expensive codes account for the vast majority of total spending.
Top 25 Codes by Total Spending, 2018–2024
| # | Code | Description | Providers | Total Paid | Avg/Provider |
|---|---|---|---|---|---|
| 1 | T1019 | Personal care services per 15 min | 9,780 | $122.74B | $12.6M |
| 2 | T1015 | Clinic service | 13,829 | $49.15B | $3.6M |
| 3 | T2016 | Habilitation residential waiver per diem | 1,761 | $34.90B | $19.8M |
| 4 | 99213 | Office/outpatient visit, est. patient | 164,075 | $33.00B | $0.2M |
| 5 | S5125 | Attendant care service per 15 min | 4,555 | $31.34B | $6.9M |
| 6 | 99214 | Office/outpatient visit, est. patient | 150,306 | $29.91B | $0.2M |
| 7 | 99284 | Emergency department visit | 21,452 | $20.15B | $0.9M |
| 8 | H2016 | Comprehensive community support, per diem | 2,115 | $19.75B | $9.3M |
| 9 | 99283 | Emergency department visit | 20,157 | $16.87B | $0.8M |
| 10 | H2015 | Comprehensive community support, 15 min | 3,908 | $16.47B | $4.2M |
| 11 | 99285 | Emergency department visit | 17,705 | $15.10B | $0.9M |
| 12 | 90837 | Psychotherapy, 60 min | 44,034 | $12.07B | $0.3M |
| 13 | S5102 | Adult day care per diem | 2,146 | $9.34B | $4.4M |
| 14 | 90834 | Psychotherapy, 45 min | 27,908 | $8.82B | $0.3M |
| 15 | T2021 | Day habilitation waiver per 15 min | 2,363 | $8.65B | $3.7M |
| 16 | H2017 | Psychosocial rehab, per 15 min | 4,499 | $8.54B | $1.9M |
| 17 | T1017 | Targeted case management | 4,498 | $8.42B | $1.9M |
| 18 | T1020 | Personal care services per diem | 1,038 | $8.21B | $7.9M |
| 19 | 90999 | Dialysis procedure | 4,989 | $7.74B | $1.6M |
| 20 | A0427 | ALS1 emergency transport | 5,789 | $7.67B | $1.3M |
| 21 | 92507 | Speech/hearing therapy | 16,583 | $7.48B | $0.5M |
| 22 | H2019 | Therapeutic behavioral services, per 15 min | 5,661 | $7.47B | $1.3M |
| 23 | T2033 | Residential, NOS waiver per diem | 716 | $7.42B | $10.4M |
| 24 | T1000 | Private duty/independent nursing | 489 | $7.01B | $14.3M |
| 25 | H2014 | Skills training and development, 15 min | 3,858 | $6.76B | $1.8M |
What the Categories Tell Us
The top 25 breaks down into a few major buckets:
Home and personal care (T1019, S5125, T1020) — $162 billion. This is the largest category by far. T1019 alone at $122.7 billion is more than double any other code. These services — helping people bathe, dress, eat, and manage daily activities — are the backbone of community-based Medicaid. They're also the most fraud-prone category, because services are delivered in private homes with limited oversight.
Residential and habilitation services (T2016, H2016, H2015, T2021, T2033) — $87 billion. Group homes and day programs for people with intellectual and developmental disabilities. The per-provider averages are high ($10-20M) because these are typically large organizations serving many residents over years.
Office visits and emergency care (99213, 99214, 99283-99285) — $115 billion. Standard outpatient and ER visits billed by 150,000+ providers each. Low per-provider averages ($200K) because this is spread across the entire healthcare system.
Behavioral health (90837, 90834, H2017, H2019) — $37 billion. Psychotherapy and psychosocial rehabilitation. 44,000 providers bill 60-minute psychotherapy (90837), reflecting the scale of behavioral health services in Medicaid.
Transportation (A0427) — $7.67 billion just for ALS emergency ambulance transport. Add in BLS emergency ($6.06B), ground mileage ($3.45B), and non-emergency trips ($2.44B), and medical transportation totals over $25 billion.
The Concentration Problem
Notice the "Average per Provider" column. Some codes have thousands of providers each billing relatively small amounts — that's normal healthcare distribution. But others show enormous per-provider averages:
- T2016 (residential waiver): 1,761 providers averaging $19.8M each
- T1000 (private duty nursing): 489 providers averaging $14.3M each
- T1019 (personal care): 9,780 providers averaging $12.6M each
- T2033 (residential NOS waiver): 716 providers averaging $10.4M each
High per-provider averages in concentrated codes create opportunities for both legitimate large-scale service delivery and for abuse. The fewer providers billing a code, the more each individual provider matters to the integrity of the whole system.
Explore Individual Codes
Every billing code in the dataset has its own page showing the top providers, total spending, and claim volumes. Click any code above to see who's billing it and how much.