Medicaid Provider Spending

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

Billing Codes in Utah

All 2,575 procedure codes billed by Medicaid providers in Utah, ranked by total spending.

#CodeDescriptionTotal Paid
1 8888888 Internal/system code - not a standard HCPCS code $542.57M
2 90837 Psychotherapy, 53 minutes with patient $261.99M
3 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $252.75M
4 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $199.78M
5 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $192.81M
6 H0018 Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem $173.72M
7 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $169.40M
8 A0380 Bls mileage (per mile) $112.95M
9 90853 Group psychotherapy (other than of a multiple-family group) $79.22M
10 T1000 Private duty / independent nursing service(s) - licensed, up to 15 minutes $77.52M
11 T1018 School-based individualized education program (iep) services, bundled $74.01M
12 81162 $71.94M
13 T1021 Home health aide or certified nurse assistant, per visit $71.66M
14 D0120 Periodic oral evaluation - established patient $70.25M
15 T2031 Assisted living; waiver, per diem $67.76M
16 H2017 Psychosocial rehabilitation services, per 15 minutes $67.09M
17 T1024 Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter $65.53M
18 T1017 Targeted case management, each 15 minutes $65.29M
19 H2016 Comprehensive community support services, per diem $59.56M
20 H2019 Therapeutic behavioral services, per 15 minutes $59.21M
21 H0046 Mental health services, not otherwise specified $51.55M
22 90791 Psychiatric diagnostic evaluation $50.50M
23 90834 Psychotherapy, 45 minutes with patient $48.77M
24 H2014 Skills training and development, per 15 minutes $48.24M
25 97155 Adaptive behavior treatment with protocol modification, administered by physician, each 15 minutes $47.87M
26 99284 Emergency department visit for the evaluation and management, high severity $45.99M
27 G0463 Hospital outpatient clinic visit for assessment and management of a patient $45.39M
28 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $43.90M
29 T1001 Nursing assessment / evaluation $39.22M
30 A0425 Ground mileage, per statute mile $38.97M
31 H2013 Psychiatric health facility service, per diem $38.47M
32 T2046 Hospice long term care, room and board only; per diem $37.10M
33 36415 Collection of venous blood by venipuncture $34.27M
34 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) $31.62M
35 H2027 Psychoeducational service, per 15 minutes $29.60M
36 T1016 Case management, each 15 minutes $28.91M
37 H2036 Alcohol and/or other drug treatment program, per diem $28.57M
38 99283 Emergency department visit for the evaluation and management, moderate severity $27.30M
39 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $27.22M
40 41899 Unlisted procedure, dentoalveolar structures $27.07M
41 A0100 Non-emergency transportation; taxi $25.89M
42 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $25.29M
43 T2005 Non-emergency transportation; stretcher van $25.01M
44 T1015 Clinic visit/encounter, all-inclusive $24.45M
45 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $24.39M
46 S5165 Home modifications; per service $23.39M
47 85025 Blood count; complete (CBC), automated, and automated differential WBC count $22.58M
48 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 $21.48M
49 T2023 Targeted case management; per month $20.94M
50 A0080 Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest $20.36M
51 S9122 Home health aide or certified nurse assistant, providing care in the home; per hour $19.18M
52 90847 Family psychotherapy with the patient present, 50 minutes $18.89M
53 90832 Psychotherapy, 30 minutes with patient $18.83M
54 99215 Prolong outpt/office vis $17.05M
55 J3490 Unclassified drugs $16.66M
56 H0038 Self-help/peer services, per 15 minutes $16.59M
57 A0130 Non-emergency transportation: wheelchair van $16.28M
58 H0012 Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient) $16.28M
59 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $16.13M
60 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $15.90M
61 T1005 Respite care services, up to 15 minutes $15.38M
62 00170 Anesthesia for intraoral procedures, including biopsy $15.26M
63 H0040 Assertive community treatment program, per diem $15.20M
64 D0140 Limited oral evaluation - problem focused $14.51M
65 D0220 Intraoral - periapical first radiographic image $14.30M
66 D1120 Prophylaxis - child $13.01M
67 D0150 Comprehensive oral evaluation - new or established patient $12.96M
68 81229 $12.75M
69 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular $12.62M
70 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 $12.31M
71 T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter $12.12M
72 S5150 Unskilled respite care, not hospice; per 15 minutes $12.09M
73 T1030 Nursing care, in the home, by registered nurse, per diem $12.01M
74 B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape $11.88M
75 D1351 Sealant - per tooth $11.70M
76 0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel $11.37M
77 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $11.27M
78 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $11.25M
79 81479 Unlisted molecular pathology procedure $11.24M
80 T1002 Rn services, up to 15 minutes $10.98M
81 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $10.89M
82 99233 Prolong inpt eval add15 m $10.44M
83 0364T $10.27M
84 81211 $10.22M
85 D2150 Silver amalgam - two surfaces, primary or permanent $10.03M
86 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 $9.74M
87 A0426 Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) $9.69M
88 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $9.56M
89 H0006 Alcohol and/or drug services; case management $9.50M
90 T2042 Hospice routine home care; per diem $9.47M
91 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 $9.38M
92 81406 $9.00M
93 96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance $8.95M
94 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $8.71M
95 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $8.54M
96 A4657 Syringe, with or without needle, each $8.51M
97 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine $8.33M
98 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 $8.18M
99 T2004 Non-emergency transport; commercial carrier, multi-pass $7.84M
100 80053 Comprehensive metabolic panel $7.81M
101 D0272 Bitewings - two radiographic images $7.71M
102 C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source $7.42M
103 E0431 Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing $7.24M
104 A0999 Unlisted ambulance service $7.12M
105 88305 Level IV - Surgical pathology, gross and microscopic examination $6.87M
106 97530 Therapeutic activities, direct patient contact, each 15 minutes $6.74M
107 A0431 Ambulance service, conventional air services, transport, one way (rotary wing) $6.59M
108 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $6.57M
109 T2003 Non-emergency transportation; encounter/trip $6.52M
110 S9131 Physical therapy; in the home, per diem $6.45M
111 J8499 Prescription drug, oral, non chemotherapeutic, nos $6.23M
112 74177 Computed tomography, abdomen and pelvis; with contrast material $6.23M
113 J1100 Injection, dexamethasone sodium phosphate, 1 mg $6.20M
114 90999 Unlisted dialysis procedure, inpatient or outpatient $6.17M
115 90792 Psychiatric diagnostic evaluation with medical services $6.14M
116 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $6.06M
117 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $6.03M
118 D1206 Topical application of fluoride varnish $5.95M
119 S9485 Crisis intervention mental health services, per diem $5.95M
120 99309 Subsequent nursing facility care, per day, low to moderate complexity $5.94M
121 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $5.91M
122 90846 Family psychotherapy without the patient present, 50 minutes $5.91M
123 G0299 Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes $5.88M
124 A0110 Non-emergency transportation and bus, intra or inter state carrier $5.79M
125 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $5.70M
126 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $5.69M
127 97151 $5.69M
128 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $5.52M
129 T2049 Non-emergency transportation; stretcher van, mileage; per mile $5.31M
130 D7140 Extraction, erupted tooth or exposed root $5.26M
131 J1885 Injection, ketorolac tromethamine, per 15 mg $5.21M
132 80050 General health panel $5.21M
133 T2029 Specialized medical equipment, not otherwise specified, waiver $5.20M
134 J0690 Injection, cefazolin sodium, 500 mg $5.20M
135 81307 $5.11M
136 99232 Subsequent hospital care, per day, moderate complexity $5.05M
137 T2033 Residential care, not otherwise specified (nos), waiver; per diem $5.03M
138 J2704 Injection, propofol, 10 mg $4.90M
139 T1003 Lpn/lvn services, up to 15 minutes $4.88M
140 99282 Emergency department visit for the evaluation and management, low to moderate severity $4.86M
141 99223 Prolong inpt eval add15 m $4.86M
142 A4554 Disposable underpads, all sizes $4.82M
143 T2007 Transportation waiting time, air ambulance and non-emergency vehicle, one-half (1/2) hour increments $4.79M
144 01967 Neuraxial labor analgesia/anesthesia for planned vaginal delivery $4.74M
145 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $4.66M
146 H2000 Comprehensive multidisciplinary evaluation $4.62M
147 A0120 Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems $4.53M
148 A4222 Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) $4.51M
149 A4221 Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) $4.50M
150 J2323 Injection, natalizumab, 1 mg $4.42M
151 71046 Radiologic examination, chest; 2 views $4.39M
152 D8080 Comprehensive orthodontic treatment of the adolescent dentition $4.30M
153 D2140 $4.30M
154 A0430 Ambulance service, conventional air services, transport, one way (fixed wing) $4.28M
155 J2405 Injection, ondansetron hydrochloride, per 1 mg $4.24M
156 70450 Computed tomography, head or brain; without contrast material $4.24M
157 99310 Prolong nursin fac eval 15m $4.11M
158 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 $4.07M
159 S5125 Attendant care services; per 15 minutes $4.01M
160 D0274 Bitewings - four radiographic images $4.00M
161 A0435 Fixed wing air mileage, per statute mile $3.98M
162 D2930 Prefabricated stainless steel crown - primary tooth $3.94M
163 B9002 Enteral nutrition infusion pump, any type $3.94M
164 J7639 Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram $3.91M
165 96361 Intravenous infusion, hydration; each additional hour $3.89M
166 E0601 Continuous positive airway pressure (cpap) device $3.82M
167 Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml $3.77M
168 71045 Radiologic examination, chest; single view $3.59M
169 D1110 Prophylaxis - adult $3.54M
170 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $3.53M
171 99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity $3.50M
172 J2250 Injection, midazolam hydrochloride, per 1 mg $3.42M
173 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 $3.41M
174 T2024 Service assessment/plan of care development, waiver $3.39M
175 D0330 Panoramic radiographic image $3.37M
176 S0209 Wheelchair van, mileage, per mile $3.35M
177 E0445 Oximeter device for measuring blood oxygen levels non-invasively $3.29M
178 J0585 Injection, onabotulinumtoxina, 1 unit $3.20M
179 D0230 Intraoral - periapical each additional radiographic image $3.13M
180 A0436 Rotary wing air mileage, per statute mile $3.09M
181 E0676 Intermittent limb compression device (includes all accessories), not otherwise specified $3.07M
182 E0465 Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) $2.99M
183 96130 $2.99M
184 71275 Computed tomographic angiography, chest, with contrast material $2.97M
185 A0390 Als mileage (per mile) $2.93M
186 V2020 Frames, purchases $2.88M
187 96131 $2.81M
188 A9576 Injection, gadoteridol, (prohance multipack), per ml $2.76M
189 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $2.67M
190 96116 $2.67M
191 A9270 Non-covered item or service $2.66M
192 85027 $2.66M
193 D2391 Resin-based composite - one surface, posterior, primary or permanent $2.64M
194 T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each $2.64M
195 A4927 Gloves, non-sterile, per 100 $2.47M
196 0368T $2.46M
197 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $2.42M
198 J2930 Injection, methylprednisolone sodium succinate, up to 125 mg $2.40M
199 B4149 Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit $2.35M
200 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed $2.34M