Medicaid Provider Spending

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

Billing Codes in South Dakota

All 1,486 procedure codes billed by Medicaid providers in South Dakota, ranked by total spending.

#CodeDescriptionTotal Paid
1 T2016 Habilitation, residential, waiver; per diem $662.65M
2 T2048 Behavioral health; long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem $185.72M
3 T2020 Day habilitation, waiver; per diem $177.59M
4 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $175.77M
5 S0281 Medical home program, comprehensive care coordination and planning, maintenance of plan $62.72M
6 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $57.88M
7 T2031 Assisted living; waiver, per diem $46.10M
8 H2016 Comprehensive community support services, per diem $39.55M
9 H2021 Community-based wrap-around services, per 15 minutes $38.94M
10 T2025 Waiver services; not otherwise specified (nos) $35.34M
11 S5125 Attendant care services; per 15 minutes $32.79M
12 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) $29.50M
13 S5130 Homemaker service, nos; per 15 minutes $29.16M
14 90837 Psychotherapy, 53 minutes with patient $28.49M
15 T1016 Case management, each 15 minutes $26.91M
16 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) $26.79M
17 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 $26.28M
18 J3490 Unclassified drugs $23.32M
19 90999 Unlisted dialysis procedure, inpatient or outpatient $20.00M
20 T1000 Private duty / independent nursing service(s) - licensed, up to 15 minutes $17.58M
21 H0039 Assertive community treatment, face-to-face, per 15 minutes $16.25M
22 A0430 Ambulance service, conventional air services, transport, one way (fixed wing) $15.32M
23 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $15.10M
24 D2930 Prefabricated stainless steel crown - primary tooth $14.17M
25 A0435 Fixed wing air mileage, per statute mile $13.35M
26 90832 Psychotherapy, 30 minutes with patient $12.73M
27 99284 Emergency department visit for the evaluation and management, high severity $12.34M
28 99232 Subsequent hospital care, per day, moderate complexity $11.90M
29 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $11.35M
30 S5135 Companion care, adult (e.g., iadl/adl); per 15 minutes $10.89M
31 S9124 Nursing care, in the home; by licensed practical nurse, per hour $10.42M
32 99283 Emergency department visit for the evaluation and management, moderate severity $10.29M
33 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $10.14M
34 T1020 Personal care services, per diem, 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) $9.81M
35 99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity $9.76M
36 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $9.63M
37 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine $9.48M
38 V2020 Frames, purchases $9.02M
39 D0120 Periodic oral evaluation - established patient $8.94M
40 36415 Collection of venous blood by venipuncture $8.70M
41 D1120 Prophylaxis - child $8.41M
42 W0037 $8.21M
43 D1206 Topical application of fluoride varnish $8.11M
44 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $7.63M
45 V2199 Not otherwise classified, single vision lens $7.38M
46 T2018 Habilitation, supported employment, waiver; per diem $7.38M
47 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $7.25M
48 90378 $7.18M
49 99215 Prolong outpt/office vis $7.03M
50 T2014 Habilitation, prevocational, waiver; per diem $6.97M
51 D7140 Extraction, erupted tooth or exposed root $6.67M
52 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $6.64M
53 90863 $6.60M
54 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $6.56M
55 T2033 Residential care, not otherwise specified (nos), waiver; per diem $6.54M
56 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $6.38M
57 99233 Prolong inpt eval add15 m $6.22M
58 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $6.11M
59 A0425 Ground mileage, per statute mile $6.05M
60 D1110 Prophylaxis - adult $5.94M
61 D1351 Sealant - per tooth $5.86M
62 G0463 Hospital outpatient clinic visit for assessment and management of a patient $5.64M
63 T2028 Specialized supply, not otherwise specified, waiver $5.60M
64 00170 Anesthesia for intraoral procedures, including biopsy $5.47M
65 98941 Chiropractic manipulative treatment; spinal, 3-4 regions $5.42M
66 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $5.28M
67 D0140 Limited oral evaluation - problem focused $5.25M
68 A0130 Non-emergency transportation: wheelchair van $5.23M
69 99223 Prolong inpt eval add15 m $5.03M
70 D2391 Resin-based composite - one surface, posterior, primary or permanent $4.96M
71 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $4.92M
72 T2017 Habilitation, residential, waiver; 15 minutes $4.82M
73 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $4.66M
74 59400 Routine obstetric care including antepartum care, vaginal delivery, and postpartum care $4.64M
75 90834 Psychotherapy, 45 minutes with patient $4.42M
76 T2019 Habilitation, supported employment, waiver; per 15 minutes $4.33M
77 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 $4.31M
78 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $4.25M
79 97530 Therapeutic activities, direct patient contact, each 15 minutes $4.12M
80 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $3.91M
81 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $3.79M
82 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $3.78M
83 S0209 Wheelchair van, mileage, per mile $3.72M
84 T1005 Respite care services, up to 15 minutes $3.64M
85 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 $3.60M
86 41899 Unlisted procedure, dentoalveolar structures $3.52M
87 90791 Psychiatric diagnostic evaluation $3.50M
88 99469 Subsequent inpatient neonatal critical care, per day, 28 days or younger $3.36M
89 D0150 Comprehensive oral evaluation - new or established patient $3.34M
90 90853 Group psychotherapy (other than of a multiple-family group) $3.25M
91 A0431 Ambulance service, conventional air services, transport, one way (rotary wing) $3.20M
92 99480 Subsequent intensive care, per day, low birth weight infant $3.16M
93 D7240 Removal of impacted tooth - completely bony $3.01M
94 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $2.96M
95 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $2.77M
96 0001A $2.76M
97 99239 Hospital discharge day management, more than 30 minutes $2.74M
98 S0215 Non-emergency transportation; mileage, per mile $2.72M
99 87651 Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe $2.71M
100 99222 Initial hospital care, per day, moderate complexity $2.66M
101 D0220 Intraoral - periapical first radiographic image $2.66M
102 74177 Computed tomography, abdomen and pelvis; with contrast material $2.66M
103 0002A $2.65M
104 H0005 Alcohol and/or drug services; group counseling by a clinician $2.56M
105 88305 Level IV - Surgical pathology, gross and microscopic examination $2.51M
106 D0272 Bitewings - two radiographic images $2.40M
107 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $2.39M
108 D0210 Intraoral - complete series of radiographic images $2.28M
109 0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel $2.28M
110 92015 Determination of refractive state $2.26M
111 80053 Comprehensive metabolic panel $2.23M
112 D9420 $2.22M
113 99238 Hospital discharge day management, 30 minutes or less $2.21M
114 99282 Emergency department visit for the evaluation and management, low to moderate severity $2.21M
115 A9270 Non-covered item or service $2.17M
116 90792 Psychiatric diagnostic evaluation with medical services $2.16M
117 S5170 Home delivered meals, including preparation; per meal $2.15M
118 D3220 Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction $2.08M
119 90472 Immunization administration, each additional vaccine (list separately) $2.05M
120 D0274 Bitewings - four radiographic images $2.02M
121 90460 Immunization administration through 18 years of age via any route, first or only component $1.96M
122 T1002 Rn services, up to 15 minutes $1.96M
123 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report $1.85M
124 D1208 Topical application of fluoride, excluding varnish $1.81M
125 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $1.81M
126 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $1.81M
127 85025 Blood count; complete (CBC), automated, and automated differential WBC count $1.80M
128 A9900 Miscellaneous dme supply, accessory, and/or service component of another hcpcs code $1.72M
129 D9223 Deep sedation/general anesthesia - each subsequent 15 minute increment $1.68M
130 D9222 $1.64M
131 70450 Computed tomography, head or brain; without contrast material $1.64M
132 H2012 Behavioral health day treatment, per hour $1.62M
133 J0585 Injection, onabotulinumtoxina, 1 unit $1.61M
134 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $1.54M
135 M0799 $1.54M
136 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed $1.52M
137 A0436 Rotary wing air mileage, per statute mile $1.51M
138 0071A $1.50M
139 87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A $1.49M
140 0072A $1.43M
141 92526 $1.42M
142 99205 Prolong outpt/office vis $1.42M
143 0202U Oncology (prostate), multianalyte, gene expression profiling $1.42M
144 87502 Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets $1.39M
145 99479 Subsequent intensive care, per day, very low birth weight infant $1.38M
146 B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape $1.36M
147 E0466 Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) $1.34M
148 71046 Radiologic examination, chest; 2 views $1.31M
149 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia $1.30M
150 99472 Subsequent inpatient pediatric critical care, per day, 2-5 years $1.28M
151 97139 $1.26M
152 D9230 Inhalation of nitrous oxide / analgesia, anxiolysis $1.24M
153 A4335 Incontinence supply; miscellaneous $1.24M
154 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $1.22M
155 71275 Computed tomographic angiography, chest, with contrast material $1.20M
156 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $1.20M
157 V2784 Lens, polycarbonate or equal, any index, per lens $1.20M
158 T4526 Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each $1.20M
159 92012 Ophthalmological services: medical examination and evaluation, intermediate, established patient $1.17M
160 Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml $1.17M
161 76819 Fetal biophysical profile; without non-stress testing $1.16M
162 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 $1.15M
163 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular $1.14M
164 T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each $1.14M
165 97155 Adaptive behavior treatment with protocol modification, administered by physician, each 15 minutes $1.14M
166 90960 End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits $1.13M
167 H0004 Behavioral health counseling and therapy, per 15 minutes $1.12M
168 99308 Subsequent nursing facility care, per day, straightforward $1.10M
169 99231 Subsequent hospital care, per day, straightforward or low complexity $1.10M
170 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $1.09M
171 99460 $1.08M
172 T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each $1.05M
173 70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences $1.04M
174 D0230 Intraoral - periapical each additional radiographic image $1.01M
175 D2140 $1.00M
176 90961 $989K
177 T1012 Alcohol and/or substance abuse services, skills development $983K
178 87804 Infectious agent antigen detection by immunoassay; Influenza, each type $970K
179 99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward $966K
180 S5161 Emergency response system; service fee, per month (excludes installation and testing) $962K
181 S9977 Meals, per diem, not otherwise specified $952K
182 00731 $949K
183 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $943K
184 90686 $917K
185 D2330 $917K
186 H2036 Alcohol and/or other drug treatment program, per diem $917K
187 D2150 Silver amalgam - two surfaces, primary or permanent $915K
188 71045 Radiologic examination, chest; single view $892K
189 0240U $891K
190 D2390 $842K
191 43235 $825K
192 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation $822K
193 J7120 Ringers lactate infusion, up to 1000 cc $803K
194 87633 Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets $800K
195 99254 $798K
196 T4528 Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each $792K
197 0054A $787K
198 97799 $768K
199 84443 Thyroid stimulating hormone (TSH) $734K
200 H0001 Alcohol and/or drug assessment $723K