Medicaid Provider Spending

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

Billing Codes in Puerto Rico

All 2,383 procedure codes billed by Medicaid providers in Puerto Rico, ranked by total spending.

#CodeDescriptionTotal Paid
1 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $136.36M
2 L8699 Prosthetic implant, not otherwise specified $104.83M
3 J9271 Injection, pembrolizumab, 1 mg $101.55M
4 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $70.57M
5 87426 Infectious agent antigen detection, SARS-CoV-2 (COVID-19) $60.59M
6 D1110 Prophylaxis - adult $52.35M
7 J9035 Injection, bevacizumab, 10 mg $51.85M
8 84443 Thyroid stimulating hormone (TSH) $50.92M
9 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $48.34M
10 80061 Lipid panel $43.08M
11 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $41.32M
12 88305 Level IV - Surgical pathology, gross and microscopic examination $40.37M
13 99283 Emergency department visit for the evaluation and management, moderate severity $39.45M
14 G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source $38.20M
15 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $38.09M
16 97533 $38.09M
17 99233 Prolong inpt eval add15 m $37.17M
18 A9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply $36.67M
19 85025 Blood count; complete (CBC), automated, and automated differential WBC count $34.76M
20 92012 Ophthalmological services: medical examination and evaluation, intermediate, established patient $34.53M
21 80053 Comprehensive metabolic panel $33.63M
22 D1999 $33.39M
23 J9299 Injection, nivolumab, 1 mg $32.10M
24 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) $31.61M
25 A0110 Non-emergency transportation and bus, intra or inter state carrier $28.54M
26 99232 Subsequent hospital care, per day, moderate complexity $27.52M
27 99284 Emergency department visit for the evaluation and management, high severity $27.37M
28 76641 $26.62M
29 J9355 Injection, trastuzumab, excludes biosimilar, 10 mg $26.33M
30 77067 Screening mammography, bilateral, including computer-aided detection $26.06M
31 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $25.45M
32 J9306 Injection, pertuzumab, 1 mg $25.23M
33 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed $23.61M
34 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $23.36M
35 D0120 Periodic oral evaluation - established patient $22.79M
36 99051 $21.83M
37 99223 Prolong inpt eval add15 m $21.57M
38 74176 Computed tomography, abdomen and pelvis; without contrast material $18.63M
39 87624 Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types $18.52M
40 D0272 Bitewings - two radiographic images $18.20M
41 S9097 Home visit for wound care $17.51M
42 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $17.34M
43 99469 Subsequent inpatient neonatal critical care, per day, 28 days or younger $17.32M
44 92002 $17.04M
45 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $16.88M
46 92015 Determination of refractive state $16.83M
47 83036 Hemoglobin; glycosylated (A1C) $16.44M
48 D0150 Comprehensive oral evaluation - new or established patient $16.42M
49 Q0084 Chemotherapy administration by infusion technique only, per visit $16.28M
50 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis $15.96M
51 92526 $15.88M
52 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $14.86M
53 99234 $14.73M
54 97032 $14.59M
55 77066 Tomosynthesis, mammo $14.55M
56 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $14.04M
57 76700 Ultrasound, abdominal, real time with image documentation; complete $13.72M
58 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $13.70M
59 D0330 Panoramic radiographic image $13.67M
60 99235 $13.50M
61 88312 $13.26M
62 J9312 Injection, rituximab, 10 mg $13.01M
63 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $12.94M
64 D1208 Topical application of fluoride, excluding varnish $12.94M
65 88142 $12.86M
66 J0897 Injection, denosumab, 1 mg $12.71M
67 88341 $12.67M
68 99215 Prolong outpt/office vis $12.36M
69 74177 Computed tomography, abdomen and pelvis; with contrast material $11.97M
70 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $11.96M
71 99070 $11.69M
72 A0425 Ground mileage, per statute mile $11.56M
73 93458 $11.47M
74 D2150 Silver amalgam - two surfaces, primary or permanent $11.46M
75 J0178 Injection, aflibercept, 1 mg $11.23M
76 G0299 Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes $11.05M
77 76830 Ultrasound, transvaginal $10.39M
78 70450 Computed tomography, head or brain; without contrast material $10.04M
79 99222 Initial hospital care, per day, moderate complexity $10.00M
80 D1120 Prophylaxis - child $9.92M
81 S9083 Global fee urgent care centers $9.89M
82 D7240 Removal of impacted tooth - completely bony $9.83M
83 88307 $9.64M
84 S9126 Hospice care, in the home, per diem $9.59M
85 82274 $9.42M
86 96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance $9.38M
87 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $9.30M
88 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $9.04M
89 93000 $8.81M
90 81000 $8.47M
91 78816 $8.41M
92 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $8.22M
93 97035 $8.06M
94 76536 $7.99M
95 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $7.80M
96 97124 $7.74M
97 J9358 Injection, fam-trastuzumab deruxtecan-nxki, 1 mg $7.68M
98 D7140 Extraction, erupted tooth or exposed root $7.53M
99 77386 $7.53M
100 71046 Radiologic examination, chest; 2 views $7.30M
101 88342 $7.29M
102 87661 Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe $7.21M
103 96160 $7.18M
104 97602 $7.08M
105 36415 Collection of venous blood by venipuncture $6.90M
106 A9277 Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system $6.83M
107 86738 $6.74M
108 87536 $6.72M
109 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed $6.67M
110 86328 $6.54M
111 45380 Colonoscopy, flexible; with biopsy, single or multiple $6.52M
112 D0230 Intraoral - periapical each additional radiographic image $6.45M
113 D2140 $6.35M
114 J9022 Injection, atezolizumab, 10 mg $6.35M
115 90832 Psychotherapy, 30 minutes with patient $6.34M
116 E0784 External ambulatory infusion pump, insulin $6.31M
117 87804 Infectious agent antigen detection by immunoassay; Influenza, each type $6.29M
118 67028 Intravitreal injection of a pharmacologic agent $6.22M
119 T1030 Nursing care, in the home, by registered nurse, per diem $6.17M
120 U0002 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc $6.00M
121 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $5.99M
122 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $5.98M
123 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine $5.82M
124 99221 $5.80M
125 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) $5.74M
126 97530 Therapeutic activities, direct patient contact, each 15 minutes $5.69M
127 J2777 Injection, faricimab-svoa, 0.1 mg $5.68M
128 99238 Hospital discharge day management, 30 minutes or less $5.67M
129 90960 End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits $5.48M
130 A9552 Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries $5.41M
131 84439 $5.37M
132 84153 $5.28M
133 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $5.28M
134 80048 Basic metabolic panel (calcium, ionized) $5.27M
135 96415 $5.17M
136 S9131 Physical therapy; in the home, per diem $5.04M
137 99205 Prolong outpt/office vis $4.93M
138 87590 $4.93M
139 A4230 Infusion set for external insulin pump, non needle cannula type $4.90M
140 71045 Radiologic examination, chest; single view $4.87M
141 80074 $4.83M
142 90472 Immunization administration, each additional vaccine (list separately) $4.74M
143 93224 $4.73M
144 87490 $4.67M
145 99236 Prolong inpt eval add15 m $4.67M
146 98942 $4.64M
147 Q5107 Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg $4.62M
148 J9055 Injection, cetuximab, 10 mg $4.60M
149 S9351 Home infusion therapy, continuous or intermittent anti-emetic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and visits coded separately), per diem $4.58M
150 A0130 Non-emergency transportation: wheelchair van $4.48M
151 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $4.43M
152 99050 $4.37M
153 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete $4.16M
154 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) $4.14M
155 92250 $4.12M
156 99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward $4.06M
157 50590 $4.06M
158 J9042 Injection, brentuximab vedotin, 1 mg $4.04M
159 99442 $4.01M
160 82043 $3.99M
161 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only $3.96M
162 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $3.93M
163 V2020 Frames, purchases $3.93M
164 T1001 Nursing assessment / evaluation $3.92M
165 76770 $3.91M
166 J9145 Injection, daratumumab, 10 mg $3.85M
167 99220 $3.84M
168 81001 $3.81M
169 96367 $3.79M
170 87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies $3.78M
171 99441 $3.78M
172 0002A $3.74M
173 99243 $3.74M
174 82607 $3.73M
175 D0220 Intraoral - periapical first radiographic image $3.68M
176 D9223 Deep sedation/general anesthesia - each subsequent 15 minute increment $3.63M
177 J9395 Injection, fulvestrant, 25 mg $3.61M
178 59515 $3.61M
179 Q5117 Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg $3.59M
180 92134 $3.58M
181 93015 $3.57M
182 88185 $3.57M
183 S9494 Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with home infusion codes for hourly dosing schedules s9497-s9504) $3.55M
184 78452 Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress $3.50M
185 J9354 Injection, ado-trastuzumab emtansine, 1 mg $3.49M
186 88365 $3.48M
187 87276 $3.47M
188 99472 Subsequent inpatient pediatric critical care, per day, 2-5 years $3.44M
189 D0160 $3.43M
190 99219 $3.38M
191 87088 $3.37M
192 E0465 Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) $3.36M
193 0001A $3.31M
194 97161 $3.26M
195 A4253 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips $3.25M
196 90837 Psychotherapy, 53 minutes with patient $3.24M
197 S9560 Home injectable therapy; hormonal therapy (e.g.; leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem $3.17M
198 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation $3.14M
199 C1874 Stent, coated/covered, with delivery system $3.10M
200 D1351 Sealant - per tooth $3.06M