All 4,120 procedure codes billed by Medicaid providers in North Carolina, ranked by total spending.
| # | Code | Description | Total Paid |
|---|---|---|---|
| 1 | 99509 | Home visit for assistance with activities of daily living and personal care | $3.35B |
| 2 | T2013 | Habilitation, educational, waiver; per hour | $1.74B |
| 3 | 99214 | Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | $1.20B |
| 4 | S5125 | Attendant care services; per 15 minutes | $1.19B |
| 5 | T1000 | Private duty / independent nursing service(s) - licensed, up to 15 minutes | $1.15B |
| 6 | 99199 | Unlisted special service, procedure or report | $942.50M |
| 7 | T2021 | Day habilitation, waiver; per 15 minutes | $934.80M |
| 8 | 99213 | Office or other outpatient visit for the evaluation and management of an established patient, low complexity | $909.41M |
| 9 | 99284 | Emergency department visit for the evaluation and management, high severity | $868.44M |
| 10 | H2022 | Community-based wrap-around services, per diem | $716.74M |
| 11 | T2012 | Habilitation, educational; waiver, per diem | $676.64M |
| 12 | 99283 | Emergency department visit for the evaluation and management, moderate severity | $651.60M |
| 13 | 92507 | Treatment of speech, language, voice, communication, and/or auditory processing disorder | $627.99M |
| 14 | H2015 | Comprehensive community support services, per 15 minutes | $596.90M |
| 15 | H0040 | Assertive community treatment program, per diem | $594.91M |
| 16 | 97153 | Adaptive behavior treatment by protocol, administered by technician, each 15 minutes | $559.07M |
| 17 | H2016 | Comprehensive community support services, per diem | $542.96M |
| 18 | T1015 | Clinic visit/encounter, all-inclusive | $513.02M |
| 19 | 90837 | Psychotherapy, 53 minutes with patient | $469.14M |
| 20 | S5145 | Foster care, therapeutic, child; per diem | $453.64M |
| 21 | 99285 | Emergency department visit for the evaluation and management, high severity with immediate threat to life | $447.54M |
| 22 | H0038 | Self-help/peer services, per 15 minutes | $397.08M |
| 23 | 97530 | Therapeutic activities, direct patient contact, each 15 minutes | $375.65M |
| 24 | 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 | $357.88M |
| 25 | H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | $327.00M |
| 26 | T2020 | Day habilitation, waiver; per diem | $305.77M |
| 27 | 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | $296.84M |
| 28 | T1017 | Targeted case management, each 15 minutes | $276.32M |
| 29 | H2017 | Psychosocial rehabilitation services, per 15 minutes | $257.06M |
| 30 | H2035 | Alcohol and/or other drug treatment program, per hour | $255.62M |
| 31 | T1016 | Case management, each 15 minutes | $245.78M |
| 32 | A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | $205.76M |
| 33 | 81420 | Fetal chromosomal aneuploidy genomic sequence analysis panel | $203.98M |
| 34 | 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 | $195.42M |
| 35 | D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | $192.20M |
| 36 | S5150 | Unskilled respite care, not hospice; per 15 minutes | $169.74M |
| 37 | D0120 | Periodic oral evaluation - established patient | $167.91M |
| 38 | T2016 | Habilitation, residential, waiver; per diem | $152.40M |
| 39 | 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) | $150.11M |
| 40 | H2012 | Behavioral health day treatment, per hour | $147.24M |
| 41 | D8670 | Periodic orthodontic treatment visit | $146.36M |
| 42 | 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | $143.51M |
| 43 | 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | $136.64M |
| 44 | D1120 | Prophylaxis - child | $132.20M |
| 45 | 90999 | Unlisted dialysis procedure, inpatient or outpatient | $129.50M |
| 46 | 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | $120.67M |
| 47 | T2041 | Supports brokerage, self-directed, waiver; per 15 minutes | $119.88M |
| 48 | 97155 | Adaptive behavior treatment with protocol modification, administered by physician, each 15 minutes | $119.29M |
| 49 | S9484 | Crisis intervention mental health services, per hour | $117.60M |
| 50 | 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | $114.02M |
| 51 | D2930 | Prefabricated stainless steel crown - primary tooth | $110.24M |
| 52 | 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | $105.44M |
| 53 | D1110 | Prophylaxis - adult | $100.74M |
| 54 | A4554 | Disposable underpads, all sizes | $99.27M |
| 55 | A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | $98.90M |
| 56 | 87798 | Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism | $91.72M |
| 57 | D2391 | Resin-based composite - one surface, posterior, primary or permanent | $90.94M |
| 58 | 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 | $87.42M |
| 59 | E0603 | Breast pump, electric (ac and/or dc), any type | $86.21M |
| 60 | 99215 | Prolong outpt/office vis | $85.65M |
| 61 | 99232 | Subsequent hospital care, per day, moderate complexity | $85.42M |
| 62 | T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | $84.73M |
| 63 | H0045 | Respite care services, not in the home, per diem | $83.77M |
| 64 | E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | $82.80M |
| 65 | H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes | $81.44M |
| 66 | 99204 | Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | $78.45M |
| 67 | 99203 | Office or other outpatient visit for the evaluation and management of a new patient, low complexity | $77.92M |
| 68 | S5135 | Companion care, adult (e.g., iadl/adl); per 15 minutes | $75.48M |
| 69 | D1206 | Topical application of fluoride varnish | $75.22M |
| 70 | H2025 | Ongoing support to maintain employment, per 15 minutes | $74.58M |
| 71 | H2033 | Multisystemic therapy for juveniles, per 15 minutes | $74.21M |
| 72 | D0150 | Comprehensive oral evaluation - new or established patient | $73.34M |
| 73 | T2014 | Habilitation, prevocational, waiver; per diem | $73.21M |
| 74 | 80053 | Comprehensive metabolic panel | $71.73M |
| 75 | 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | $70.78M |
| 76 | 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 | $69.73M |
| 77 | 0241U | Neonatal screening for hereditary disorders, genomic sequence analysis panel | $69.47M |
| 78 | H2011 | Crisis intervention service, per 15 minutes | $69.36M |
| 79 | D8080 | Comprehensive orthodontic treatment of the adolescent dentition | $69.35M |
| 80 | T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | $68.76M |
| 81 | 74177 | Computed tomography, abdomen and pelvis; with contrast material | $68.39M |
| 82 | A0120 | Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems | $68.21M |
| 83 | 81220 | CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants | $67.02M |
| 84 | 90460 | Immunization administration through 18 years of age via any route, first or only component | $66.30M |
| 85 | T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | $64.68M |
| 86 | 99233 | Prolong inpt eval add15 m | $64.08M |
| 87 | 90472 | Immunization administration, each additional vaccine (list separately) | $63.55M |
| 88 | 92508 | Group treatment of speech, language, voice, communication, and/or auditory processing disorder | $63.23M |
| 89 | D1351 | Sealant - per tooth | $61.62M |
| 90 | T2033 | Residential care, not otherwise specified (nos), waiver; per diem | $61.54M |
| 91 | 99282 | Emergency department visit for the evaluation and management, low to moderate severity | $60.97M |
| 92 | D0330 | Panoramic radiographic image | $60.41M |
| 93 | A4927 | Gloves, non-sterile, per 100 | $59.67M |
| 94 | 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 | $59.46M |
| 95 | 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | $59.37M |
| 96 | 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 | $59.01M |
| 97 | 87661 | Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe | $58.28M |
| 98 | G0463 | Hospital outpatient clinic visit for assessment and management of a patient | $58.21M |
| 99 | D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | $58.19M |
| 100 | 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | $57.30M |
| 101 | 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 | $56.34M |
| 102 | 87801 | Infectious agent detection by nucleic acid; amplified probe, multiple organisms | $55.76M |
| 103 | D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | $55.57M |
| 104 | T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | $55.10M |
| 105 | 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | $53.06M |
| 106 | D7140 | Extraction, erupted tooth or exposed root | $52.25M |
| 107 | 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | $51.31M |
| 108 | 88305 | Level IV - Surgical pathology, gross and microscopic examination | $49.70M |
| 109 | D0220 | Intraoral - periapical first radiographic image | $49.38M |
| 110 | D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | $49.14M |
| 111 | T2025 | Waiver services; not otherwise specified (nos) | $47.13M |
| 112 | G0330 | Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room | $47.09M |
| 113 | S0621 | Routine ophthalmological examination including refraction; established patient | $46.42M |
| 114 | 80061 | Lipid panel | $46.35M |
| 115 | D7240 | Removal of impacted tooth - completely bony | $45.96M |
| 116 | S0620 | Routine ophthalmological examination including refraction; new patient | $45.70M |
| 117 | 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | $45.34M |
| 118 | H2023 | Supported employment, per 15 minutes | $44.87M |
| 119 | D0274 | Bitewings - four radiographic images | $44.85M |
| 120 | B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | $43.53M |
| 121 | T4535 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each | $42.19M |
| 122 | T4532 | Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each | $41.77M |
| 123 | A4353 | Intermittent urinary catheter, with insertion supplies | $40.99M |
| 124 | D0230 | Intraoral - periapical each additional radiographic image | $40.04M |
| 125 | D1208 | Topical application of fluoride, excluding varnish | $39.43M |
| 126 | D9223 | Deep sedation/general anesthesia - each subsequent 15 minute increment | $39.40M |
| 127 | 90834 | Psychotherapy, 45 minutes with patient | $39.17M |
| 128 | 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | $39.10M |
| 129 | 84443 | Thyroid stimulating hormone (TSH) | $38.90M |
| 130 | D0140 | Limited oral evaluation - problem focused | $38.78M |
| 131 | 70450 | Computed tomography, head or brain; without contrast material | $37.30M |
| 132 | B4161 | Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit | $36.82M |
| 133 | 99244 | Office or other outpatient consultation, moderate to high complexity | $36.45M |
| 134 | D0272 | Bitewings - two radiographic images | $35.46M |
| 135 | 87636 | Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B | $35.08M |
| 136 | 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 | $34.54M |
| 137 | E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | $34.28M |
| 138 | E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | $34.25M |
| 139 | 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | $34.15M |
| 140 | 41899 | Unlisted procedure, dentoalveolar structures | $33.64M |
| 141 | 99309 | Subsequent nursing facility care, per day, low to moderate complexity | $33.23M |
| 142 | 86003 | $32.22M | |
| 143 | T4544 | Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each | $32.15M |
| 144 | D8680 | $32.07M | |
| 145 | A0431 | Ambulance service, conventional air services, transport, one way (rotary wing) | $32.05M |
| 146 | 87637 | Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV | $31.36M |
| 147 | 93005 | Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | $30.40M |
| 148 | T4541 | Incontinence product, disposable underpad, large, each | $30.09M |
| 149 | 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | $29.28M |
| 150 | 76816 | Ultrasound, pregnant uterus, real time with image documentation, follow-up | $28.74M |
| 151 | 96374 | Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance | $28.56M |
| 152 | 71046 | Radiologic examination, chest; 2 views | $28.26M |
| 153 | 83036 | Hemoglobin; glycosylated (A1C) | $28.09M |
| 154 | 90832 | Psychotherapy, 30 minutes with patient | $28.05M |
| 155 | T1005 | Respite care services, up to 15 minutes | $28.02M |
| 156 | 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | $27.60M |
| 157 | 71045 | Radiologic examination, chest; single view | $26.36M |
| 158 | J3490 | Unclassified drugs | $26.16M |
| 159 | E1399 | Durable medical equipment, miscellaneous | $25.54M |
| 160 | 90847 | Family psychotherapy with the patient present, 50 minutes | $25.09M |
| 161 | 90791 | Psychiatric diagnostic evaluation | $24.99M |
| 162 | 99469 | Subsequent inpatient neonatal critical care, per day, 28 days or younger | $24.72M |
| 163 | 96110 | Developmental screening, with scoring and documentation, per standardized instrument | $24.38M |
| 164 | 95165 | Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials | $24.21M |
| 165 | 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | $24.15M |
| 166 | 97110 | Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion | $23.82M |
| 167 | 88175 | Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer | $23.07M |
| 168 | D0145 | Oral evaluation for a patient under three years of age | $22.87M |
| 169 | T2027 | Specialized childcare, waiver; per 15 minutes | $22.66M |
| 170 | 99223 | Prolong inpt eval add15 m | $22.54M |
| 171 | 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | $22.00M |
| 172 | T2003 | Non-emergency transportation; encounter/trip | $21.94M |
| 173 | E0445 | Oximeter device for measuring blood oxygen levels non-invasively | $21.62M |
| 174 | B4160 | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit | $21.21M |
| 175 | 95004 | Percutaneous tests with allergenic extracts, immediate type reaction | $20.76M |
| 176 | B4150 | Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit | $20.45M |
| 177 | 87502 | Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets | $20.37M |
| 178 | 87624 | Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types | $20.27M |
| 179 | 92340 | Fitting of spectacles, except for aphakia; monofocal | $19.37M |
| 180 | J1745 | Injection, infliximab, excludes biosimilar, 10 mg | $19.22M |
| 181 | A0425 | Ground mileage, per statute mile | $19.11M |
| 182 | A6530 | Gradient compression stocking, below knee, 18-30 mmhg, each | $18.61M |
| 183 | E0601 | Continuous positive airway pressure (cpap) device | $18.58M |
| 184 | 81229 | $18.56M | |
| 185 | 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | $18.46M |
| 186 | 87086 | Culture, bacterial; quantitative colony count, urine | $18.10M |
| 187 | 36415 | Collection of venous blood by venipuncture | $17.81M |
| 188 | 99336 | $17.80M | |
| 189 | H2020 | Therapeutic behavioral services, per diem | $17.64M |
| 190 | A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply | $17.50M |
| 191 | E0570 | Nebulizer, with compressor | $17.42M |
| 192 | D9222 | $17.40M | |
| 193 | H0032 | Mental health service plan development by non-physician | $17.23M |
| 194 | B4154 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit | $17.06M |
| 195 | 76811 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed | $17.02M |
| 196 | 87651 | Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe | $16.54M |
| 197 | 99472 | Subsequent inpatient pediatric critical care, per day, 2-5 years | $16.41M |
| 198 | V2020 | Frames, purchases | $16.38M |
| 199 | A9274 | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories | $16.33M |
| 200 | 99479 | Subsequent intensive care, per day, very low birth weight infant | $16.29M |