Medicaid Provider Spending

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

Billing Codes in District of Columbia

All 2,120 procedure codes billed by Medicaid providers in District of Columbia, ranked by total spending.

#CodeDescriptionTotal Paid
1 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) $1.38B
2 H0036 Community psychiatric supportive treatment, face-to-face, per 15 minutes $796.12M
3 T2016 Habilitation, residential, waiver; per diem $559.01M
4 T1015 Clinic visit/encounter, all-inclusive $187.57M
5 H0039 Assertive community treatment, face-to-face, per 15 minutes $155.92M
6 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $136.24M
7 99283 Emergency department visit for the evaluation and management, moderate severity $124.26M
8 99284 Emergency department visit for the evaluation and management, high severity $117.30M
9 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $99.03M
10 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $98.90M
11 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $91.85M
12 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $76.45M
13 H0044 Supported housing, per month $75.70M
14 H0025 Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior) $69.93M
15 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $67.22M
16 T2033 Residential care, not otherwise specified (nos), waiver; per diem $63.57M
17 T2021 Day habilitation, waiver; per 15 minutes $62.93M
18 99509 Home visit for assistance with activities of daily living and personal care $58.66M
19 S5135 Companion care, adult (e.g., iadl/adl); per 15 minutes $56.55M
20 H0034 Medication training and support, per 15 minutes $53.20M
21 90837 Psychotherapy, 53 minutes with patient $51.40M
22 T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter $48.02M
23 T2031 Assisted living; waiver, per diem $41.66M
24 G0299 Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes $40.23M
25 90999 Unlisted dialysis procedure, inpatient or outpatient $39.95M
26 T1000 Private duty / independent nursing service(s) - licensed, up to 15 minutes $39.64M
27 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $36.98M
28 96361 Intravenous infusion, hydration; each additional hour $35.16M
29 99215 Prolong outpt/office vis $34.78M
30 H0004 Behavioral health counseling and therapy, per 15 minutes $33.48M
31 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 $29.33M
32 T2003 Non-emergency transportation; encounter/trip $28.82M
33 99282 Emergency department visit for the evaluation and management, low to moderate severity $27.30M
34 S5100 Day care services, adult; per 15 minutes $26.11M
35 70450 Computed tomography, head or brain; without contrast material $25.80M
36 H2022 Community-based wrap-around services, per diem $23.33M
37 A6250 Skin sealants, protectants, moisturizers, ointments, any type, any size $23.18M
38 S9124 Nursing care, in the home; by licensed practical nurse, per hour $22.52M
39 G0463 Hospital outpatient clinic visit for assessment and management of a patient $22.07M
40 97530 Therapeutic activities, direct patient contact, each 15 minutes $21.11M
41 99233 Prolong inpt eval add15 m $20.41M
42 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $18.48M
43 99232 Subsequent hospital care, per day, moderate complexity $17.90M
44 99281 Emergency department visit for the evaluation and management, self-limited or minor $17.46M
45 74177 Computed tomography, abdomen and pelvis; with contrast material $16.56M
46 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $16.14M
47 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $15.70M
48 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $14.94M
49 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 $14.91M
50 G0300 Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes $14.31M
51 D1110 Prophylaxis - adult $14.26M
52 H0040 Assertive community treatment program, per diem $14.04M
53 A0425 Ground mileage, per statute mile $11.95M
54 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $11.89M
55 90834 Psychotherapy, 45 minutes with patient $11.76M
56 D0120 Periodic oral evaluation - established patient $11.73M
57 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $11.60M
58 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $11.50M
59 T2019 Habilitation, supported employment, waiver; per 15 minutes $11.43M
60 S9485 Crisis intervention mental health services, per diem $11.25M
61 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $10.94M
62 G0378 Hospital observation service, per hour $10.25M
63 T2022 Case management, per month $10.20M
64 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $10.19M
65 90791 Psychiatric diagnostic evaluation $10.07M
66 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $10.01M
67 D1120 Prophylaxis - child $9.59M
68 59025 Fetal non-stress test $9.35M
69 S9451 Exercise classes, non-physician provider, per session $9.26M
70 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $8.81M
71 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $8.68M
72 45380 Colonoscopy, flexible; with biopsy, single or multiple $8.67M
73 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction $8.38M
74 J9271 Injection, pembrolizumab, 1 mg $7.99M
75 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis $7.78M
76 99223 Prolong inpt eval add15 m $7.75M
77 71275 Computed tomographic angiography, chest, with contrast material $7.38M
78 A4554 Disposable underpads, all sizes $7.35M
79 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $7.23M
80 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $7.19M
81 42820 Tonsillectomy and adenoidectomy; younger than age 12 $7.07M
82 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour $7.02M
83 D8080 Comprehensive orthodontic treatment of the adolescent dentition $6.85M
84 D0150 Comprehensive oral evaluation - new or established patient $6.72M
85 99472 Subsequent inpatient pediatric critical care, per day, 2-5 years $6.50M
86 74176 Computed tomography, abdomen and pelvis; without contrast material $6.50M
87 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) $6.37M
88 D0999 Unspecified diagnostic procedure, by report $6.31M
89 S0281 Medical home program, comprehensive care coordination and planning, maintenance of plan $6.29M
90 97150 Therapeutic procedure(s), group (2 or more individuals) $6.23M
91 T4523 Adult sized disposable incontinence product, brief/diaper, large, each $6.03M
92 D0274 Bitewings - four radiographic images $5.92M
93 D1208 Topical application of fluoride, excluding varnish $5.89M
94 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $5.68M
95 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) $5.56M
96 96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour $5.49M
97 D2750 $5.44M
98 T2023 Targeted case management; per month $5.39M
99 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete $5.38M
100 T2015 Habilitation, prevocational, waiver; per hour $5.37M
101 H2014 Skills training and development, per 15 minutes $5.36M
102 D2391 Resin-based composite - one surface, posterior, primary or permanent $5.26M
103 70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences $5.24M
104 0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel $5.23M
105 D2930 Prefabricated stainless steel crown - primary tooth $5.16M
106 77067 Screening mammography, bilateral, including computer-aided detection $4.91M
107 S5170 Home delivered meals, including preparation; per meal $4.88M
108 D1206 Topical application of fluoride varnish $4.81M
109 H0002 Behavioral health screening to determine eligibility for admission to treatment program $4.70M
110 D3330 Endodontic therapy, molar tooth (excluding final restoration) $4.56M
111 D0330 Panoramic radiographic image $4.49M
112 T4524 Adult sized disposable incontinence product, brief/diaper, extra large, each $4.42M
113 93303 Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study $4.36M
114 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $4.16M
115 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $4.12M
116 D0140 Limited oral evaluation - problem focused $4.08M
117 97535 Self-care/home management training, each 15 minutes $3.95M
118 70551 Magnetic resonance imaging, brain; without contrast material $3.95M
119 90832 Psychotherapy, 30 minutes with patient $3.85M
120 71046 Radiologic examination, chest; 2 views $3.74M
121 97162 $3.73M
122 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $3.72M
123 95810 Polysomnography; sleep staging with 4 or more additional parameters $3.68M
124 D0272 Bitewings - two radiographic images $3.67M
125 D0220 Intraoral - periapical first radiographic image $3.63M
126 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $3.62M
127 96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance $3.60M
128 90853 Group psychotherapy (other than of a multiple-family group) $3.56M
129 88305 Level IV - Surgical pathology, gross and microscopic examination $3.44M
130 90792 Psychiatric diagnostic evaluation with medical services $3.43M
131 H0023 Behavioral health outreach service (planned approach to reach a targeted population) $3.36M
132 H2027 Psychoeducational service, per 15 minutes $3.35M
133 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $3.32M
134 19083 $3.29M
135 A4927 Gloves, non-sterile, per 100 $3.28M
136 97161 $3.28M
137 20610 $3.20M
138 77063 Screening digital breast tomosynthesis, bilateral $3.18M
139 99205 Prolong outpt/office vis $3.18M
140 G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes $3.11M
141 99244 Office or other outpatient consultation, moderate to high complexity $3.08M
142 D4249 $3.08M
143 96131 $3.07M
144 H0005 Alcohol and/or drug services; group counseling by a clinician $3.02M
145 T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each $2.99M
146 71260 Computed tomography, thorax, diagnostic; with contrast material $2.97M
147 G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes $2.96M
148 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 $2.90M
149 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $2.87M
150 76705 Ultrasound, abdominal, real time with image documentation; limited $2.87M
151 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia $2.86M
152 99309 Subsequent nursing facility care, per day, low to moderate complexity $2.81M
153 90960 End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits $2.81M
154 77412 $2.77M
155 D2393 Resin-based composite - three surfaces, posterior, primary or permanent $2.77M
156 T4522 Adult sized disposable incontinence product, brief/diaper, medium, each $2.76M
157 78815 Positron emission tomography (PET) for limited area imaging $2.75M
158 D1351 Sealant - per tooth $2.71M
159 76830 Ultrasound, transvaginal $2.69M
160 S9470 Nutritional counseling, dietitian visit $2.68M
161 11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm $2.67M
162 77386 $2.65M
163 T2017 Habilitation, residential, waiver; 15 minutes $2.61M
164 S9125 Respite care, in the home, per diem $2.55M
165 92012 Ophthalmological services: medical examination and evaluation, intermediate, established patient $2.53M
166 76700 Ultrasound, abdominal, real time with image documentation; complete $2.51M
167 76642 $2.50M
168 71045 Radiologic examination, chest; single view $2.47M
169 H2011 Crisis intervention service, per 15 minutes $2.43M
170 99231 Subsequent hospital care, per day, straightforward or low complexity $2.40M
171 96415 $2.40M
172 93971 $2.37M
173 99469 Subsequent inpatient neonatal critical care, per day, 28 days or younger $2.30M
174 93970 $2.22M
175 Q4081 Injection, epoetin alfa, 100 units (for esrd on dialysis) $2.21M
176 G9012 Other specified case management service not elsewhere classified $2.17M
177 D9310 $2.17M
178 T1017 Targeted case management, each 15 minutes $2.16M
179 C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source $2.16M
180 D7140 Extraction, erupted tooth or exposed root $2.15M
181 V2784 Lens, polycarbonate or equal, any index, per lens $2.14M
182 D0230 Intraoral - periapical each additional radiographic image $2.14M
183 A6260 Wound cleansers, any type, any size $2.11M
184 99308 Subsequent nursing facility care, per day, straightforward $2.07M
185 99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward $2.06M
186 T4543 Adult sized disposable incontinence product, protective brief/diaper, above extra large, each $2.05M
187 92550 $2.02M
188 97116 $2.00M
189 99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity $1.97M
190 76815 Ultrasound, pregnant uterus, real time with image documentation, limited $1.96M
191 76770 $1.93M
192 99222 Initial hospital care, per day, moderate complexity $1.90M
193 99243 $1.86M
194 72148 Magnetic resonance imaging, lumbar spine; without contrast material $1.86M
195 S9484 Crisis intervention mental health services, per hour $1.86M
196 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $1.85M
197 J0887 Injection, epoetin beta, 1 microgram, (for esrd on dialysis) $1.84M
198 41899 Unlisted procedure, dentoalveolar structures $1.82M
199 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only $1.77M
200 97010 $1.75M