Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

Billing Codes in California

All 6,886 procedure codes billed by Medicaid providers in California, ranked by total spending.

#CodeDescriptionTotal Paid
1 T1015 Clinic visit/encounter, all-inclusive $21.79B
2 H2015 Comprehensive community support services, per 15 minutes $8.35B
3 00003 Internal/system code - not a standard HCPCS code $5.32B
4 S5102 Day care services, adult; per diem $3.29B
5 90999 Unlisted dialysis procedure, inpatient or outpatient $3.28B
6 H2010 Comprehensive medication services, per 15 minutes $3.19B
7 H2017 Psychosocial rehabilitation services, per 15 minutes $3.02B
8 T1017 Targeted case management, each 15 minutes $2.63B
9 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $2.26B
10 H2019 Therapeutic behavioral services, per 15 minutes $2.07B
11 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $1.79B
12 90837 Psychotherapy, 53 minutes with patient $1.72B
13 99283 Emergency department visit for the evaluation and management, moderate severity $1.65B
14 0450 Emergency room services $1.61B
15 S9484 Crisis intervention mental health services, per hour $1.56B
16 H0019 Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem $1.54B
17 H0032 Mental health service plan development by non-physician $1.49B
18 T2031 Assisted living; waiver, per diem $1.44B
19 99284 Emergency department visit for the evaluation and management, high severity $1.23B
20 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $1.22B
21 D0120 Periodic oral evaluation - established patient $923.63M
22 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $915.11M
23 H0004 Behavioral health counseling and therapy, per 15 minutes $909.13M
24 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $863.75M
25 G0300 Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes $802.46M
26 H0034 Medication training and support, per 15 minutes $733.14M
27 D1120 Prophylaxis - child $724.81M
28 U0003 Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r $668.51M
29 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $589.55M
30 81420 Fetal chromosomal aneuploidy genomic sequence analysis panel $575.75M
31 D0150 Comprehensive oral evaluation - new or established patient $572.23M
32 99215 Prolong outpt/office vis $571.70M
33 H2011 Crisis intervention service, per 15 minutes $568.11M
34 H0018 Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem $566.12M
35 A0425 Ground mileage, per statute mile $558.63M
36 H2013 Psychiatric health facility service, per diem $532.82M
37 0659 Rehabilitation services, other $495.81M
38 99233 Prolong inpt eval add15 m $489.44M
39 G9012 Other specified case management service not elsewhere classified $467.60M
40 74177 Computed tomography, abdomen and pelvis; with contrast material $442.98M
41 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $428.97M
42 A0130 Non-emergency transportation: wheelchair van $426.00M
43 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $422.58M
44 99232 Subsequent hospital care, per day, moderate complexity $396.58M
45 H0005 Alcohol and/or drug services; group counseling by a clinician $363.50M
46 D0230 Intraoral - periapical each additional radiographic image $363.22M
47 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $349.80M
48 90834 Psychotherapy, 45 minutes with patient $348.02M
49 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $340.53M
50 99281 Emergency department visit for the evaluation and management, self-limited or minor $331.05M
51 A0380 Bls mileage (per mile) $323.46M
52 D2930 Prefabricated stainless steel crown - primary tooth $315.33M
53 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $314.31M
54 G0299 Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes $310.14M
55 T4541 Incontinence product, disposable underpad, large, each $308.03M
56 D1110 Prophylaxis - adult $307.74M
57 70450 Computed tomography, head or brain; without contrast material $302.18M
58 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $302.12M
59 G2212 Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes) $285.95M
60 80053 Comprehensive metabolic panel $283.80M
61 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $283.24M
62 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $275.32M
63 99223 Prolong inpt eval add15 m $273.95M
64 S9124 Nursing care, in the home; by licensed practical nurse, per hour $267.53M
65 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $264.41M
66 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $249.97M
67 T2005 Non-emergency transportation; stretcher van $246.15M
68 G0483 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed $233.90M
69 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $233.33M
70 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $232.14M
71 G0482 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed $231.66M
72 G0467 Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit $226.11M
73 J3490 Unclassified drugs $223.01M
74 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $222.53M
75 D1351 Sealant - per tooth $221.92M
76 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $215.14M
77 D1208 Topical application of fluoride, excluding varnish $206.75M
78 77067 Screening mammography, bilateral, including computer-aided detection $203.90M
79 T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each $199.56M
80 D2150 Silver amalgam - two surfaces, primary or permanent $196.33M
81 J9271 Injection, pembrolizumab, 1 mg $195.70M
82 G9008 Coordinated care fee, physician coordinated care oversight services $195.17M
83 T1019 Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant) $195.13M
84 0121 $195.04M
85 96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance $194.75M
86 0510 $193.86M
87 0821 $185.29M
88 D0210 Intraoral - complete series of radiographic images $183.77M
89 D1310 $181.05M
90 T2033 Residential care, not otherwise specified (nos), waiver; per diem $180.35M
91 67028 Intravitreal injection of a pharmacologic agent $178.30M
92 H0031 Mental health assessment, by non-physician $177.55M
93 81220 CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants $176.66M
94 E0784 External ambulatory infusion pump, insulin $175.88M
95 85025 Blood count; complete (CBC), automated, and automated differential WBC count $175.45M
96 D7140 Extraction, erupted tooth or exposed root $175.15M
97 0658 $171.66M
98 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $168.87M
99 D3220 Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction $168.76M
100 H0006 Alcohol and/or drug services; case management $167.52M
101 88305 Level IV - Surgical pathology, gross and microscopic examination $162.36M
102 78815 Positron emission tomography (PET) for limited area imaging $162.24M
103 D2751 Crown - porcelain fused to predominantly base metal $160.04M
104 74176 Computed tomography, abdomen and pelvis; without contrast material $160.01M
105 87637 Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV $158.95M
106 0120 $157.79M
107 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $156.96M
108 59425 $153.61M
109 H0043 Supported housing, per diem $152.42M
110 99199 Unlisted special service, procedure or report $151.42M
111 99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward $149.29M
112 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report $148.93M
113 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $147.14M
114 0650 Inj, levothyroxine, hikma $146.90M
115 90960 End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits $146.44M
116 71045 Radiologic examination, chest; single view $144.74M
117 D0274 Bitewings - four radiographic images $142.36M
118 H2012 Behavioral health day treatment, per hour $140.22M
119 97530 Therapeutic activities, direct patient contact, each 15 minutes $138.78M
120 D2391 Resin-based composite - one surface, posterior, primary or permanent $138.61M
121 D8670 Periodic orthodontic treatment visit $135.66M
122 90832 Psychotherapy, 30 minutes with patient $134.57M
123 00069 $132.25M
124 99205 Prolong outpt/office vis $131.54M
125 J0178 Injection, aflibercept, 1 mg $130.17M
126 A0390 Als mileage (per mile) $130.02M
127 A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply $129.50M
128 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis $127.24M
129 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $126.09M
130 96130 $122.92M
131 D9223 Deep sedation/general anesthesia - each subsequent 15 minute increment $122.21M
132 G0481 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed $121.58M
133 G0378 Hospital observation service, per hour $119.96M
134 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular $119.60M
135 G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes $119.04M
136 81408 $119.04M
137 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $118.86M
138 G9002 Coordinated care fee, maintenance rate $118.25M
139 71046 Radiologic examination, chest; 2 views $117.35M
140 V5298 Hearing aid, not otherwise classified $116.65M
141 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $116.24M
142 G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed $116.13M
143 D3330 Endodontic therapy, molar tooth (excluding final restoration) $115.86M
144 D1206 Topical application of fluoride varnish $115.45M
145 96375 Therapeutic injection; each additional sequential IV push $114.50M
146 99282 Emergency department visit for the evaluation and management, low to moderate severity $110.93M
147 T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each $108.95M
148 90791 Psychiatric diagnostic evaluation $108.88M
149 D9230 Inhalation of nitrous oxide / analgesia, anxiolysis $107.91M
150 H0012 Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient) $105.80M
151 70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences $102.58M
152 D4341 $102.00M
153 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $101.22M
154 G0463 Hospital outpatient clinic visit for assessment and management of a patient $100.98M
155 84443 Thyroid stimulating hormone (TSH) $100.76M
156 T1026 Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per hour $99.79M
157 T4526 Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each $98.95M
158 Z7502 $98.17M
159 90945 $97.11M
160 D0350 $97.02M
161 T4523 Adult sized disposable incontinence product, brief/diaper, large, each $96.76M
162 D2740 Crown - porcelain/ceramic $96.73M
163 81519 $95.75M
164 J7307 Etonogestrel (contraceptive) implant system, including implant and supplies $94.66M
165 E0465 Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) $94.05M
166 D9430 $93.42M
167 99499 $92.54M
168 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only $91.90M
169 45380 Colonoscopy, flexible; with biopsy, single or multiple $91.79M
170 A4351 Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each $91.47M
171 0360 $90.38M
172 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $89.64M
173 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $89.01M
174 D9993 $88.79M
175 U0004 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r $88.73M
176 A0100 Non-emergency transportation; taxi $88.58M
177 D0272 Bitewings - two radiographic images $88.04M
178 A4230 Infusion set for external insulin pump, non needle cannula type $87.19M
179 87636 Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B $87.08M
180 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $86.49M
181 D2140 $85.88M
182 80061 Lipid panel $85.83M
183 90847 Family psychotherapy with the patient present, 50 minutes $85.76M
184 0160 $85.33M
185 H0046 Mental health services, not otherwise specified $83.84M
186 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) $83.63M
187 S9083 Global fee urgent care centers $83.22M
188 81508 $83.05M
189 S9977 Meals, per diem, not otherwise specified $83.03M
190 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $81.60M
191 99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity $80.68M
192 59409 Vaginal delivery only (with or without episiotomy and/or forceps) $80.22M
193 0250 $79.85M
194 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete $79.29M
195 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed $78.55M
196 D0220 Intraoral - periapical first radiographic image $78.33M
197 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed $77.85M
198 E0466 Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) $77.85M
199 87633 Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets $77.81M
200 0551 $77.47M