Medicaid Provider Spending

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

Billing Codes in Delaware

All 2,181 procedure codes billed by Medicaid providers in Delaware, ranked by total spending.

#CodeDescriptionTotal Paid
1 S5130 Homemaker service, nos; per 15 minutes $530.82M
2 T2025 Waiver services; not otherwise specified (nos) $508.02M
3 T2016 Habilitation, residential, waiver; per diem $204.54M
4 S9124 Nursing care, in the home; by licensed practical nurse, per hour $177.24M
5 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $118.12M
6 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $100.32M
7 S5125 Attendant care services; per 15 minutes $99.64M
8 99283 Emergency department visit for the evaluation and management, moderate severity $88.18M
9 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) $75.48M
10 T2020 Day habilitation, waiver; per diem $69.78M
11 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) $69.19M
12 99284 Emergency department visit for the evaluation and management, high severity $65.91M
13 H0040 Assertive community treatment program, per diem $53.18M
14 90837 Psychotherapy, 53 minutes with patient $49.17M
15 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $45.03M
16 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $44.64M
17 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 $44.04M
18 H0036 Community psychiatric supportive treatment, face-to-face, per 15 minutes $42.24M
19 T2040 Financial management, self-directed, waiver; per 15 minutes $33.07M
20 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $32.96M
21 T1025 Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem $30.76M
22 T2023 Targeted case management; per month $27.82M
23 G0299 Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes $25.72M
24 H2036 Alcohol and/or other drug treatment program, per diem $25.32M
25 D8670 Periodic orthodontic treatment visit $24.94M
26 99282 Emergency department visit for the evaluation and management, low to moderate severity $22.78M
27 99232 Subsequent hospital care, per day, moderate complexity $21.38M
28 T2022 Case management, per month $21.30M
29 D1120 Prophylaxis - child $18.95M
30 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $17.49M
31 D0120 Periodic oral evaluation - established patient $17.45M
32 T1015 Clinic visit/encounter, all-inclusive $17.03M
33 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $16.98M
34 T2033 Residential care, not otherwise specified (nos), waiver; per diem $16.69M
35 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $16.67M
36 99215 Prolong outpt/office vis $16.22M
37 99233 Prolong inpt eval add15 m $15.49M
38 S5170 Home delivered meals, including preparation; per meal $15.18M
39 90834 Psychotherapy, 45 minutes with patient $15.16M
40 T1001 Nursing assessment / evaluation $15.12M
41 D1206 Topical application of fluoride varnish $14.97M
42 D1351 Sealant - per tooth $14.55M
43 97530 Therapeutic activities, direct patient contact, each 15 minutes $14.30M
44 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $14.19M
45 S9083 Global fee urgent care centers $13.81M
46 T2014 Habilitation, prevocational, waiver; per diem $13.46M
47 D1110 Prophylaxis - adult $13.41M
48 D2391 Resin-based composite - one surface, posterior, primary or permanent $13.25M
49 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $12.90M
50 T2019 Habilitation, supported employment, waiver; per 15 minutes $12.83M
51 99472 Subsequent inpatient pediatric critical care, per day, 2-5 years $12.50M
52 G0156 Services of home health/hospice aide in home health or hospice settings, each 15 minutes $11.76M
53 74177 Computed tomography, abdomen and pelvis; with contrast material $11.48M
54 D2930 Prefabricated stainless steel crown - primary tooth $11.17M
55 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $10.88M
56 G0378 Hospital observation service, per hour $10.61M
57 H2011 Crisis intervention service, per 15 minutes $10.33M
58 99281 Emergency department visit for the evaluation and management, self-limited or minor $10.26M
59 G0175 Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present $9.53M
60 0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel $9.46M
61 41899 Unlisted procedure, dentoalveolar structures $9.35M
62 D8090 $9.30M
63 S5105 Day care services, center-based; services not included in program fee, per diem $9.27M
64 S5165 Home modifications; per service $8.99M
65 99223 Prolong inpt eval add15 m $8.91M
66 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $8.89M
67 H0018 Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem $8.82M
68 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $8.80M
69 D8020 $8.55M
70 D2393 Resin-based composite - three surfaces, posterior, primary or permanent $8.36M
71 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $8.36M
72 G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes $8.13M
73 D9223 Deep sedation/general anesthesia - each subsequent 15 minute increment $7.97M
74 D7140 Extraction, erupted tooth or exposed root $7.94M
75 D0150 Comprehensive oral evaluation - new or established patient $7.82M
76 90999 Unlisted dialysis procedure, inpatient or outpatient $7.68M
77 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $7.68M
78 D0274 Bitewings - four radiographic images $7.23M
79 H0037 Community psychiatric supportive treatment program, per diem $7.08M
80 T1024 Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter $6.96M
81 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $6.62M
82 99222 Initial hospital care, per day, moderate complexity $6.57M
83 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report $6.36M
84 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $6.21M
85 G0300 Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes $6.15M
86 85025 Blood count; complete (CBC), automated, and automated differential WBC count $6.08M
87 D8660 $5.92M
88 T2002 Non-emergency transportation; per diem $5.83M
89 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 $5.78M
90 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 $5.68M
91 J2357 Injection, omalizumab, 5 mg $5.64M
92 D0272 Bitewings - two radiographic images $5.58M
93 93303 Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study $5.56M
94 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $5.55M
95 80053 Comprehensive metabolic panel $5.54M
96 J9271 Injection, pembrolizumab, 1 mg $5.54M
97 J0585 Injection, onabotulinumtoxina, 1 unit $5.49M
98 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $5.40M
99 D0330 Panoramic radiographic image $5.35M
100 99469 Subsequent inpatient neonatal critical care, per day, 28 days or younger $5.33M
101 D0220 Intraoral - periapical first radiographic image $5.26M
102 70450 Computed tomography, head or brain; without contrast material $5.21M
103 59409 Vaginal delivery only (with or without episiotomy and/or forceps) $5.10M
104 T2021 Day habilitation, waiver; per 15 minutes $5.10M
105 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 $5.09M
106 H0010 Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) $5.01M
107 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $4.98M
108 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $4.88M
109 99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity $4.81M
110 88305 Level IV - Surgical pathology, gross and microscopic examination $4.78M
111 96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance $4.75M
112 J1745 Injection, infliximab, excludes biosimilar, 10 mg $4.67M
113 G9008 Coordinated care fee, physician coordinated care oversight services $4.66M
114 D0230 Intraoral - periapical each additional radiographic image $4.65M
115 90791 Psychiatric diagnostic evaluation $4.60M
116 H0004 Behavioral health counseling and therapy, per 15 minutes $4.43M
117 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $4.36M
118 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $4.33M
119 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $4.32M
120 99205 Prolong outpt/office vis $4.19M
121 S5150 Unskilled respite care, not hospice; per 15 minutes $4.15M
122 T2030 Assisted living, waiver; per month $3.97M
123 H0038 Self-help/peer services, per 15 minutes $3.93M
124 76819 Fetal biophysical profile; without non-stress testing $3.92M
125 D9230 Inhalation of nitrous oxide / analgesia, anxiolysis $3.88M
126 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $3.75M
127 G0470 Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit $3.63M
128 99238 Hospital discharge day management, 30 minutes or less $3.60M
129 98941 Chiropractic manipulative treatment; spinal, 3-4 regions $3.56M
130 G0463 Hospital outpatient clinic visit for assessment and management of a patient $3.53M
131 87637 Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV $3.51M
132 S9128 Speech therapy, in the home, per diem $3.46M
133 96375 Therapeutic injection; each additional sequential IV push $3.45M
134 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia $3.32M
135 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $3.21M
136 D0140 Limited oral evaluation - problem focused $3.21M
137 90847 Family psychotherapy with the patient present, 50 minutes $3.20M
138 S9485 Crisis intervention mental health services, per diem $3.09M
139 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $2.98M
140 V2020 Frames, purchases $2.95M
141 90832 Psychotherapy, 30 minutes with patient $2.95M
142 96361 Intravenous infusion, hydration; each additional hour $2.95M
143 71045 Radiologic examination, chest; single view $2.93M
144 93325 $2.89M
145 99173 $2.85M
146 99395 Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years $2.76M
147 01967 Neuraxial labor analgesia/anesthesia for planned vaginal delivery $2.70M
148 99239 Hospital discharge day management, more than 30 minutes $2.70M
149 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $2.65M
150 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $2.62M
151 93320 $2.60M
152 80048 Basic metabolic panel (calcium, ionized) $2.57M
153 99480 Subsequent intensive care, per day, low birth weight infant $2.57M
154 00170 Anesthesia for intraoral procedures, including biopsy $2.54M
155 71275 Computed tomographic angiography, chest, with contrast material $2.53M
156 70551 Magnetic resonance imaging, brain; without contrast material $2.50M
157 95810 Polysomnography; sleep staging with 4 or more additional parameters $2.50M
158 V2100 Sphere, single vision, plano to plus or minus 4.00, per lens $2.48M
159 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $2.46M
160 77067 Screening mammography, bilateral, including computer-aided detection $2.45M
161 01922 $2.44M
162 99231 Subsequent hospital care, per day, straightforward or low complexity $2.43M
163 74176 Computed tomography, abdomen and pelvis; without contrast material $2.41M
164 71046 Radiologic examination, chest; 2 views $2.40M
165 E1399 Durable medical equipment, miscellaneous $2.38M
166 G0466 Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new 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 $2.28M
167 H2033 Multisystemic therapy for juveniles, per 15 minutes $2.25M
168 S9131 Physical therapy; in the home, per diem $2.25M
169 90686 $2.24M
170 96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance $2.24M
171 T2015 Habilitation, prevocational, waiver; per hour $2.22M
172 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular $2.16M
173 99396 Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years $2.15M
174 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete $2.15M
175 76801 $2.14M
176 G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes $2.13M
177 36415 Collection of venous blood by venipuncture $2.13M
178 96110 Developmental screening, with scoring and documentation, per standardized instrument $2.06M
179 59514 $2.04M
180 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 $2.01M
181 99460 $2.00M
182 87633 Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets $1.98M
183 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed $1.97M
184 J0129 Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) $1.89M
185 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only $1.81M
186 V5008 Hearing screening $1.80M
187 43775 $1.80M
188 Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml $1.80M
189 99309 Subsequent nursing facility care, per day, low to moderate complexity $1.79M
190 76830 Ultrasound, transvaginal $1.78M
191 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 $1.77M
192 D0240 $1.75M
193 E0601 Continuous positive airway pressure (cpap) device $1.74M
194 D0210 Intraoral - complete series of radiographic images $1.73M
195 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal $1.68M
196 80050 General health panel $1.68M
197 99479 Subsequent intensive care, per day, very low birth weight infant $1.68M
198 S5161 Emergency response system; service fee, per month (excludes installation and testing) $1.67M
199 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction $1.66M
200 S9129 Occupational therapy, in the home, per diem $1.66M