Medicaid Provider Spending

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

Billing Codes in Ohio

All 4,687 procedure codes billed by Medicaid providers in Ohio, 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) $2.58B
2 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $1.71B
3 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $1.65B
4 H2019 Therapeutic behavioral services, per 15 minutes $1.51B
5 T2046 Hospice long term care, room and board only; per diem $1.32B
6 G0156 Services of home health/hospice aide in home health or hospice settings, each 15 minutes $1.22B
7 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 $1.18B
8 90837 Psychotherapy, 53 minutes with patient $1.08B
9 99284 Emergency department visit for the evaluation and management, high severity $969.23M
10 G0463 Hospital outpatient clinic visit for assessment and management of a patient $889.69M
11 99283 Emergency department visit for the evaluation and management, moderate severity $885.97M
12 T1015 Clinic visit/encounter, all-inclusive $825.24M
13 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $736.41M
14 H2036 Alcohol and/or other drug treatment program, per diem $681.69M
15 H0036 Community psychiatric supportive treatment, face-to-face, per 15 minutes $492.11M
16 T1000 Private duty / independent nursing service(s) - licensed, up to 15 minutes $485.59M
17 H2020 Therapeutic behavioral services, per diem $452.83M
18 96361 Intravenous infusion, hydration; each additional hour $429.20M
19 H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) $349.26M
20 G0299 Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes $305.22M
21 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $301.43M
22 G0300 Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes $298.63M
23 90999 Unlisted dialysis procedure, inpatient or outpatient $287.83M
24 T2031 Assisted living; waiver, per diem $275.53M
25 S5170 Home delivered meals, including preparation; per meal $262.62M
26 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $221.18M
27 H0006 Alcohol and/or drug services; case management $219.38M
28 90834 Psychotherapy, 45 minutes with patient $195.63M
29 E2510 Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access $192.90M
30 T1502 Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit $185.54M
31 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $185.09M
32 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $184.54M
33 90832 Psychotherapy, 30 minutes with patient $183.18M
34 70450 Computed tomography, head or brain; without contrast material $181.88M
35 74177 Computed tomography, abdomen and pelvis; with contrast material $169.63M
36 S5000 Prescription drug, generic $168.90M
37 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $158.63M
38 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 $151.71M
39 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $140.65M
40 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $136.60M
41 97530 Therapeutic activities, direct patient contact, each 15 minutes $133.71M
42 H0005 Alcohol and/or drug services; group counseling by a clinician $133.12M
43 D7140 Extraction, erupted tooth or exposed root $133.10M
44 99215 Prolong outpt/office vis $131.27M
45 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $129.79M
46 A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply $126.61M
47 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $123.48M
48 99282 Emergency department visit for the evaluation and management, low to moderate severity $123.00M
49 H2017 Psychosocial rehabilitation services, per 15 minutes $121.19M
50 T2042 Hospice routine home care; per diem $117.80M
51 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $112.45M
52 J9271 Injection, pembrolizumab, 1 mg $110.65M
53 99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity $108.38M
54 90791 Psychiatric diagnostic evaluation $106.93M
55 99232 Subsequent hospital care, per day, moderate complexity $105.52M
56 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $101.45M
57 80053 Comprehensive metabolic panel $96.93M
58 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $92.79M
59 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $91.53M
60 D2930 Prefabricated stainless steel crown - primary tooth $90.41M
61 J2350 Injection, ocrelizumab, 1 mg $90.12M
62 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $89.43M
63 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $86.35M
64 V2020 Frames, purchases $84.67M
65 G0378 Hospital observation service, per hour $82.03M
66 D1110 Prophylaxis - adult $78.88M
67 99233 Prolong inpt eval add15 m $78.78M
68 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $78.08M
69 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $77.43M
70 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $75.94M
71 H0048 Alcohol and/or other drug testing: collection and handling only, specimens other than blood $75.66M
72 96110 Developmental screening, with scoring and documentation, per standardized instrument $75.08M
73 90460 Immunization administration through 18 years of age via any route, first or only component $74.94M
74 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $73.27M
75 74176 Computed tomography, abdomen and pelvis; without contrast material $72.88M
76 H2034 Alcohol and/or drug abuse halfway house services, per diem $70.06M
77 D0120 Periodic oral evaluation - established patient $69.13M
78 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $68.63M
79 H0040 Assertive community treatment program, per diem $66.95M
80 A0425 Ground mileage, per statute mile $66.40M
81 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 $66.37M
82 D8670 Periodic orthodontic treatment visit $65.54M
83 T2022 Case management, per month $64.48M
84 E0784 External ambulatory infusion pump, insulin $63.72M
85 88305 Level IV - Surgical pathology, gross and microscopic examination $62.74M
86 D0150 Comprehensive oral evaluation - new or established patient $62.59M
87 D0330 Panoramic radiographic image $58.60M
88 A4230 Infusion set for external insulin pump, non needle cannula type $58.58M
89 84443 Thyroid stimulating hormone (TSH) $58.50M
90 T1016 Case management, each 15 minutes $58.02M
91 D1120 Prophylaxis - child $57.90M
92 W1793 State-specific procedure code $57.39M
93 G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes $57.34M
94 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia $56.81M
95 T1002 Rn services, up to 15 minutes $55.55M
96 96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour $54.66M
97 87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies $54.18M
98 D2391 Resin-based composite - one surface, posterior, primary or permanent $52.36M
99 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction $51.62M
100 85025 Blood count; complete (CBC), automated, and automated differential WBC count $51.37M
101 E0603 Breast pump, electric (ac and/or dc), any type $51.19M
102 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $50.45M
103 80061 Lipid panel $50.31M
104 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed $49.46M
105 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $48.90M
106 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $48.02M
107 96127 $48.01M
108 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $47.84M
109 H0010 Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) $46.81M
110 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $44.93M
111 H0014 Alcohol and/or drug services; ambulatory detoxification $44.64M
112 H0038 Self-help/peer services, per 15 minutes $43.90M
113 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour $43.36M
114 V2103 Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens $43.26M
115 71275 Computed tomographic angiography, chest, with contrast material $42.95M
116 92551 $42.16M
117 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 $41.48M
118 J2315 Injection, naltrexone, depot form, 1 mg $41.35M
119 V2784 Lens, polycarbonate or equal, any index, per lens $41.29M
120 E0466 Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) $41.16M
121 90853 Group psychotherapy (other than of a multiple-family group) $41.10M
122 J0585 Injection, onabotulinumtoxina, 1 unit $41.05M
123 0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel $40.86M
124 99223 Prolong inpt eval add15 m $40.05M
125 99309 Subsequent nursing facility care, per day, low to moderate complexity $39.62M
126 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 $39.23M
127 A0431 Ambulance service, conventional air services, transport, one way (rotary wing) $38.78M
128 59025 Fetal non-stress test $38.72M
129 90833 Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on) $38.45M
130 E0465 Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) $38.41M
131 90847 Family psychotherapy with the patient present, 50 minutes $38.40M
132 T1003 Lpn/lvn services, up to 15 minutes $37.49M
133 95810 Polysomnography; sleep staging with 4 or more additional parameters $36.89M
134 E0601 Continuous positive airway pressure (cpap) device $36.13M
135 98941 Chiropractic manipulative treatment; spinal, 3-4 regions $36.08M
136 D1351 Sealant - per tooth $36.08M
137 96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance $36.07M
138 S5165 Home modifications; per service $35.38M
139 S5102 Day care services, adult; per diem $35.29M
140 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $35.11M
141 A9277 Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system $34.20M
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 $33.30M
143 80050 General health panel $33.12M
144 83036 Hemoglobin; glycosylated (A1C) $32.91M
145 K1034 Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count $32.75M
146 80048 Basic metabolic panel (calcium, ionized) $32.66M
147 D0274 Bitewings - four radiographic images $32.23M
148 D2393 Resin-based composite - three surfaces, posterior, primary or permanent $32.05M
149 A0130 Non-emergency transportation: wheelchair van $32.04M
150 S9340 Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem $31.96M
151 71046 Radiologic examination, chest; 2 views $31.69M
152 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $31.18M
153 99308 Subsequent nursing facility care, per day, straightforward $30.69M
154 T4541 Incontinence product, disposable underpad, large, each $30.39M
155 E2617 Custom fabricated wheelchair back cushion, any size, including any type mounting hardware $30.25M
156 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only $30.15M
157 E2609 Custom fabricated wheelchair seat cushion, any size $29.89M
158 41899 Unlisted procedure, dentoalveolar structures $29.84M
159 70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences $29.57M
160 B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape $29.46M
161 D1208 Topical application of fluoride, excluding varnish $29.32M
162 E1007 Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction $29.31M
163 E1161 Manual adult size wheelchair, includes tilt in space $29.29M
164 T2023 Targeted case management; per month $28.59M
165 J3490 Unclassified drugs $28.36M
166 T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each $28.05M
167 36415 Collection of venous blood by venipuncture $27.56M
168 71045 Radiologic examination, chest; single view $27.48M
169 42820 Tonsillectomy and adenoidectomy; younger than age 12 $27.22M
170 D0140 Limited oral evaluation - problem focused $27.06M
171 71260 Computed tomography, thorax, diagnostic; with contrast material $27.01M
172 00170 Anesthesia for intraoral procedures, including biopsy $26.69M
173 D0210 Intraoral - complete series of radiographic images $26.55M
174 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $26.19M
175 H0004 Behavioral health counseling and therapy, per 15 minutes $26.06M
176 D1206 Topical application of fluoride varnish $25.90M
177 J2323 Injection, natalizumab, 1 mg $25.86M
178 V2100 Sphere, single vision, plano to plus or minus 4.00, per lens $25.80M
179 K0553 Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service $25.66M
180 G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes $25.44M
181 T4528 Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each $25.28M
182 T2029 Specialized medical equipment, not otherwise specified, waiver $24.84M
183 J0178 Injection, aflibercept, 1 mg $24.55M
184 87636 Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B $24.39M
185 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 $24.39M
186 45380 Colonoscopy, flexible; with biopsy, single or multiple $24.38M
187 77386 $24.00M
188 81420 Fetal chromosomal aneuploidy genomic sequence analysis panel $23.85M
189 T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each $23.74M
190 E2402 Negative pressure wound therapy electrical pump, stationary or portable $23.66M
191 92015 Determination of refractive state $23.25M
192 T4526 Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each $23.07M
193 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $23.03M
194 E0570 Nebulizer, with compressor $22.82M
195 T1001 Nursing assessment / evaluation $22.69M
196 20610 $22.63M
197 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed $22.25M
198 99395 Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years $22.16M
199 90792 Psychiatric diagnostic evaluation with medical services $21.88M
200 90785 $21.75M