Medicaid Provider Spending

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

Billing Codes in Connecticut

All 3,750 procedure codes billed by Medicaid providers in Connecticut, ranked by total spending.

#CodeDescriptionTotal Paid
1 T1015 Clinic visit/encounter, all-inclusive $1.75B
2 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $758.99M
3 T1502 Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit $644.50M
4 99284 Emergency department visit for the evaluation and management, high severity $597.32M
5 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $527.23M
6 90837 Psychotherapy, 53 minutes with patient $441.22M
7 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $417.03M
8 99283 Emergency department visit for the evaluation and management, moderate severity $387.80M
9 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $381.71M
10 G0463 Hospital outpatient clinic visit for assessment and management of a patient $278.38M
11 S9124 Nursing care, in the home; by licensed practical nurse, per hour $231.01M
12 S9123 Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used) $212.09M
13 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $186.99M
14 T1004 Services of a qualified nursing aide, up to 15 minutes $177.55M
15 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $164.45M
16 H2036 Alcohol and/or other drug treatment program, per diem $138.93M
17 96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance $135.38M
18 5140Z $134.70M
19 H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education $119.43M
20 H2019 Therapeutic behavioral services, per 15 minutes $114.07M
21 90834 Psychotherapy, 45 minutes with patient $112.66M
22 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $100.17M
23 J2350 Injection, ocrelizumab, 1 mg $86.49M
24 90832 Psychotherapy, 30 minutes with patient $83.12M
25 D1120 Prophylaxis - child $79.00M
26 S9480 Intensive outpatient psychiatric services, per diem $74.10M
27 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $72.05M
28 74177 Computed tomography, abdomen and pelvis; with contrast material $70.59M
29 D0120 Periodic oral evaluation - established patient $58.74M
30 T2048 Behavioral health; long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem $58.05M
31 J9271 Injection, pembrolizumab, 1 mg $57.91M
32 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $57.13M
33 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $56.00M
34 1021Z $54.98M
35 90853 Group psychotherapy (other than of a multiple-family group) $54.33M
36 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $54.13M
37 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $53.28M
38 99282 Emergency department visit for the evaluation and management, low to moderate severity $52.65M
39 92015 Determination of refractive state $52.29M
40 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $52.00M
41 90791 Psychiatric diagnostic evaluation $50.47M
42 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $49.13M
43 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $48.10M
44 H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) $47.95M
45 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 $46.72M
46 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $46.22M
47 J0178 Injection, aflibercept, 1 mg $45.96M
48 96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance $45.73M
49 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $45.23M
50 71046 Radiologic examination, chest; 2 views $43.78M
51 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $42.82M
52 S0215 Non-emergency transportation; mileage, per mile $42.23M
53 D8670 Periodic orthodontic treatment visit $41.73M
54 45380 Colonoscopy, flexible; with biopsy, single or multiple $41.36M
55 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $40.22M
56 5140Y $39.07M
57 90460 Immunization administration through 18 years of age via any route, first or only component $38.90M
58 99215 Prolong outpt/office vis $37.79M
59 96361 Intravenous infusion, hydration; each additional hour $37.78M
60 D1208 Topical application of fluoride, excluding varnish $37.04M
61 J1745 Injection, infliximab, excludes biosimilar, 10 mg $36.95M
62 70450 Computed tomography, head or brain; without contrast material $36.91M
63 88305 Level IV - Surgical pathology, gross and microscopic examination $36.54M
64 95810 Polysomnography; sleep staging with 4 or more additional parameters $35.73M
65 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $33.98M
66 A0100 Non-emergency transportation; taxi $33.94M
67 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour $32.95M
68 G0162 Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting) $32.23M
69 97530 Therapeutic activities, direct patient contact, each 15 minutes $31.54M
70 99232 Subsequent hospital care, per day, moderate complexity $30.98M
71 90847 Family psychotherapy with the patient present, 50 minutes $30.94M
72 77067 Screening mammography, bilateral, including computer-aided detection $30.85M
73 42820 Tonsillectomy and adenoidectomy; younger than age 12 $30.74M
74 D2391 Resin-based composite - one surface, posterior, primary or permanent $29.36M
75 96375 Therapeutic injection; each additional sequential IV push $29.03M
76 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $28.21M
77 99309 Subsequent nursing facility care, per day, low to moderate complexity $27.83M
78 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $27.21M
79 V2020 Frames, purchases $27.17M
80 59025 Fetal non-stress test $26.82M
81 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $26.58M
82 90999 Unlisted dialysis procedure, inpatient or outpatient $25.45M
83 D0274 Bitewings - four radiographic images $25.29M
84 D0150 Comprehensive oral evaluation - new or established patient $24.53M
85 78452 Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress $24.48M
86 D1110 Prophylaxis - adult $24.46M
87 J1459 Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg $24.02M
88 1286Z $23.99M
89 J2323 Injection, natalizumab, 1 mg $23.80M
90 D0140 Limited oral evaluation - problem focused $23.18M
91 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $22.84M
92 1201Z $22.08M
93 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $21.36M
94 T1017 Targeted case management, each 15 minutes $21.24M
95 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $20.38M
96 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) $20.24M
97 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $20.11M
98 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $20.09M
99 70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences $20.00M
100 74176 Computed tomography, abdomen and pelvis; without contrast material $19.90M
101 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $19.90M
102 0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel $19.89M
103 H0035 Mental health partial hospitalization, treatment, less than 24 hours $19.62M
104 J0585 Injection, onabotulinumtoxina, 1 unit $19.26M
105 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $18.87M
106 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $18.78M
107 71045 Radiologic examination, chest; single view $18.51M
108 D1206 Topical application of fluoride varnish $18.44M
109 95004 Percutaneous tests with allergenic extracts, immediate type reaction $18.27M
110 A0425 Ground mileage, per statute mile $18.14M
111 G0384 Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) $18.05M
112 99233 Prolong inpt eval add15 m $17.74M
113 D0330 Panoramic radiographic image $17.72M
114 H2034 Alcohol and/or drug abuse halfway house services, per diem $17.20M
115 J3357 Ustekinumab, for subcutaneous injection, 1 mg $17.13M
116 D7140 Extraction, erupted tooth or exposed root $16.86M
117 11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm $16.65M
118 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $16.56M
119 97010 $16.25M
120 92340 Fitting of spectacles, except for aphakia; monofocal $16.23M
121 G0511 Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month $16.20M
122 K0553 Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service $16.01M
123 76705 Ultrasound, abdominal, real time with image documentation; limited $15.83M
124 99308 Subsequent nursing facility care, per day, straightforward $15.73M
125 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 $15.69M
126 H2012 Behavioral health day treatment, per hour $15.55M
127 A4253 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips $15.18M
128 1023Z $15.11M
129 V2103 Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens $14.69M
130 76830 Ultrasound, transvaginal $14.66M
131 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed $14.65M
132 71260 Computed tomography, thorax, diagnostic; with contrast material $14.05M
133 H2013 Psychiatric health facility service, per diem $13.79M
134 U0005 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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 $13.70M
135 D1351 Sealant - per tooth $13.54M
136 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular $13.51M
137 J9299 Injection, nivolumab, 1 mg $13.40M
138 J3380 Injection, vedolizumab, intravenous, 1 mg $13.06M
139 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis $13.03M
140 J2357 Injection, omalizumab, 5 mg $12.86M
141 47562 $12.61M
142 78815 Positron emission tomography (PET) for limited area imaging $12.60M
143 96131 $12.21M
144 5140X $12.10M
145 96127 $12.08M
146 D2930 Prefabricated stainless steel crown - primary tooth $12.07M
147 D2393 Resin-based composite - three surfaces, posterior, primary or permanent $12.05M
148 97161 $12.04M
149 S0580 Polycarbonate lens (list this code in addition to the basic code for the lens) $11.94M
150 93975 $11.88M
151 A4239 Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service $11.59M
152 D0272 Bitewings - two radiographic images $11.46M
153 B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape $11.40M
154 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) $11.12M
155 E1161 Manual adult size wheelchair, includes tilt in space $11.00M
156 T4541 Incontinence product, disposable underpad, large, each $10.99M
157 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $10.97M
158 D0210 Intraoral - complete series of radiographic images $10.88M
159 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $10.60M
160 72125 Computed tomography, cervical spine; without contrast material $10.50M
161 D0220 Intraoral - periapical first radiographic image $10.40M
162 90792 Psychiatric diagnostic evaluation with medical services $10.38M
163 92250 $10.38M
164 G0382 Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) $10.22M
165 J0897 Injection, denosumab, 1 mg $10.16M
166 D9223 Deep sedation/general anesthesia - each subsequent 15 minute increment $10.09M
167 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) $10.06M
168 D9230 Inhalation of nitrous oxide / analgesia, anxiolysis $9.98M
169 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete $9.91M
170 J2505 Injection, pegfilgrastim, 6 mg $9.85M
171 93458 $9.67M
172 87636 Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B $9.62M
173 72148 Magnetic resonance imaging, lumbar spine; without contrast material $9.50M
174 J9312 Injection, rituximab, 10 mg $9.48M
175 76641 $9.41M
176 87637 Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV $9.25M
177 G0379 Direct admission of patient for hospital observation care $9.17M
178 99244 Office or other outpatient consultation, moderate to high complexity $9.11M
179 76801 $9.09M
180 71275 Computed tomographic angiography, chest, with contrast material $9.05M
181 G0383 Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) $8.98M
182 87426 Infectious agent antigen detection, SARS-CoV-2 (COVID-19) $8.98M
183 93303 Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study $8.91M
184 92587 $8.80M
185 95811 $8.69M
186 81420 Fetal chromosomal aneuploidy genomic sequence analysis panel $8.65M
187 2074Y $8.63M
188 93971 $8.60M
189 86900 $8.50M
190 90960 End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits $8.49M
191 99223 Prolong inpt eval add15 m $8.42M
192 H0046 Mental health services, not otherwise specified $8.42M
193 97162 $8.38M
194 27447 $8.33M
195 J9144 Injection, daratumumab, 10 mg and hyaluronidase-fihj $8.15M
196 T1001 Nursing assessment / evaluation $8.15M
197 D7240 Removal of impacted tooth - completely bony $8.09M
198 76700 Ultrasound, abdominal, real time with image documentation; complete $8.04M
199 T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each $8.02M
200 70551 Magnetic resonance imaging, brain; without contrast material $7.99M