Medicaid Provider Spending

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

Billing Codes in Washington

All 3,676 procedure codes billed by Medicaid providers in Washington, ranked by total spending.

#CodeDescriptionTotal Paid
1 T1015 Clinic visit/encounter, all-inclusive $3.20B
2 99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity $692.22M
3 99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity $550.66M
4 99283 Emergency department visit for the evaluation and management, moderate severity $418.49M
5 99284 Emergency department visit for the evaluation and management, high severity $411.19M
6 A0999 Unlisted ambulance service $396.18M
7 G0463 Hospital outpatient clinic visit for assessment and management of a patient $391.16M
8 99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life $339.94M
9 H0018 Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem $287.49M
10 96361 Intravenous infusion, hydration; each additional hour $274.21M
11 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) $246.83M
12 90837 Psychotherapy, 53 minutes with patient $242.64M
13 90999 Unlisted dialysis procedure, inpatient or outpatient $212.01M
14 T1000 Private duty / independent nursing service(s) - licensed, up to 15 minutes $176.15M
15 H0004 Behavioral health counseling and therapy, per 15 minutes $157.09M
16 74177 Computed tomography, abdomen and pelvis; with contrast material $147.46M
17 97530 Therapeutic activities, direct patient contact, each 15 minutes $144.49M
18 80307 Drug test(s), presumptive, any number of drug classes; immunoassay $134.00M
19 G9149 National committee for quality assurance - level 2 medical home $132.49M
20 D0120 Periodic oral evaluation - established patient $120.52M
21 T1013 Sign language or oral interpretive services, per 15 minutes $113.17M
22 T1041 Medicaid certified community behavioral health clinic services, per month $109.75M
23 J7170 Injection, emicizumab-kxwh, 0.5 mg $108.69M
24 A0429 Ambulance service, basic life support, emergency transport (bls-emergency) $107.74M
25 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 $103.10M
26 D2392 Resin-based composite - two surfaces, posterior, primary or permanent $101.20M
27 96165 $96.55M
28 E1399 Durable medical equipment, miscellaneous $90.42M
29 D2930 Prefabricated stainless steel crown - primary tooth $86.67M
30 H0043 Supported housing, per diem $86.16M
31 97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion $86.12M
32 99282 Emergency department visit for the evaluation and management, low to moderate severity $85.44M
33 D9223 Deep sedation/general anesthesia - each subsequent 15 minute increment $82.23M
34 D1120 Prophylaxis - child $81.84M
35 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 $78.38M
36 70450 Computed tomography, head or brain; without contrast material $75.90M
37 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder $74.16M
38 D1206 Topical application of fluoride varnish $71.41M
39 99215 Prolong outpt/office vis $69.02M
40 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour $64.20M
41 A0425 Ground mileage, per statute mile $63.97M
42 D8080 Comprehensive orthodontic treatment of the adolescent dentition $63.79M
43 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 $60.22M
44 90834 Psychotherapy, 45 minutes with patient $59.56M
45 T2025 Waiver services; not otherwise specified (nos) $58.76M
46 D2391 Resin-based composite - one surface, posterior, primary or permanent $56.88M
47 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 $55.93M
48 T1030 Nursing care, in the home, by registered nurse, per diem $55.91M
49 H2014 Skills training and development, per 15 minutes $55.29M
50 87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe $53.92M
51 T2035 Utility services to support medical equipment and assistive technology/devices, waiver $52.90M
52 87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe $52.05M
53 D1110 Prophylaxis - adult $50.06M
54 99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity $49.95M
55 99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) $49.15M
56 D0150 Comprehensive oral evaluation - new or established patient $46.45M
57 99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) $46.44M
58 99232 Subsequent hospital care, per day, moderate complexity $46.35M
59 99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity $46.07M
60 96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour $45.89M
61 S9430 Pharmacy compounding and dispensing services $45.87M
62 80053 Comprehensive metabolic panel $45.64M
63 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 $45.48M
64 93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete $43.92M
65 D1351 Sealant - per tooth $41.86M
66 99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward $41.32M
67 J9271 Injection, pembrolizumab, 1 mg $40.81M
68 A0427 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) $40.65M
69 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple $39.41M
70 H2015 Comprehensive community support services, per 15 minutes $39.16M
71 99233 Prolong inpt eval add15 m $38.69M
72 D0140 Limited oral evaluation - problem focused $38.50M
73 D7140 Extraction, erupted tooth or exposed root $38.32M
74 D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth $36.85M
75 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour $36.56M
76 B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape $36.23M
77 97153 Adaptive behavior treatment by protocol, administered by technician, each 15 minutes $35.43M
78 T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each $35.39M
79 H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) $35.35M
80 74176 Computed tomography, abdomen and pelvis; without contrast material $34.37M
81 H2023 Supported employment, per 15 minutes $34.13M
82 J7192 Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified $33.64M
83 S9485 Crisis intervention mental health services, per diem $33.40M
84 E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate $33.35M
85 92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient $33.33M
86 A4927 Gloves, non-sterile, per 100 $33.06M
87 99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) $33.02M
88 97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) $32.43M
89 Q5001 Hospice or home health care provided in patient's home/residence $31.68M
90 92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient $31.57M
91 T1002 Rn services, up to 15 minutes $31.54M
92 D0330 Panoramic radiographic image $31.11M
93 96164 $30.52M
94 D7240 Removal of impacted tooth - completely bony $30.33M
95 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 $30.08M
96 59025 Fetal non-stress test $30.08M
97 D0220 Intraoral - periapical first radiographic image $29.77M
98 S9480 Intensive outpatient psychiatric services, per diem $29.38M
99 88305 Level IV - Surgical pathology, gross and microscopic examination $29.15M
100 S5102 Day care services, adult; per diem $28.56M
101 00170 Anesthesia for intraoral procedures, including biopsy $27.54M
102 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) $26.93M
103 90832 Psychotherapy, 30 minutes with patient $26.80M
104 85025 Blood count; complete (CBC), automated, and automated differential WBC count $26.68M
105 H2022 Community-based wrap-around services, per diem $26.29M
106 T4541 Incontinence product, disposable underpad, large, each $25.61M
107 T4526 Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each $25.35M
108 76705 Ultrasound, abdominal, real time with image documentation; limited $25.11M
109 97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination $24.42M
110 H0038 Self-help/peer services, per 15 minutes $24.08M
111 H2013 Psychiatric health facility service, per diem $23.99M
112 45380 Colonoscopy, flexible; with biopsy, single or multiple $23.72M
113 87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe $23.59M
114 H2036 Alcohol and/or other drug treatment program, per diem $23.44M
115 71275 Computed tomographic angiography, chest, with contrast material $23.22M
116 J0178 Injection, aflibercept, 1 mg $23.20M
117 A0428 Ambulance service, basic life support, non-emergency transport, (bls) $23.19M
118 D1208 Topical application of fluoride, excluding varnish $23.09M
119 80050 General health panel $22.91M
120 G0378 Hospital observation service, per hour $22.89M
121 D9999 Unspecified adjunctive procedure, by report $22.32M
122 E0601 Continuous positive airway pressure (cpap) device $22.07M
123 H0001 Alcohol and/or drug assessment $22.04M
124 96153 $21.79M
125 T4528 Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each $21.68M
126 A4222 Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) $21.27M
127 T4537 Incontinence product, protective underpad, reusable, bed size, each $21.25M
128 D9222 $21.09M
129 D0272 Bitewings - two radiographic images $20.31M
130 T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each $20.25M
131 36415 Collection of venous blood by venipuncture $20.17M
132 J1745 Injection, infliximab, excludes biosimilar, 10 mg $20.08M
133 A4657 Syringe, with or without needle, each $19.67M
134 90791 Psychiatric diagnostic evaluation $19.61M
135 84443 Thyroid stimulating hormone (TSH) $19.39M
136 D9230 Inhalation of nitrous oxide / analgesia, anxiolysis $19.38M
137 80061 Lipid panel $19.05M
138 D8670 Periodic orthodontic treatment visit $18.89M
139 96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance $18.85M
140 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) $18.76M
141 99223 Prolong inpt eval add15 m $18.75M
142 J0585 Injection, onabotulinumtoxina, 1 unit $18.68M
143 71046 Radiologic examination, chest; 2 views $18.41M
144 H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem $17.58M
145 76830 Ultrasound, transvaginal $17.52M
146 99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes $17.40M
147 95810 Polysomnography; sleep staging with 4 or more additional parameters $17.12M
148 D5110 $17.10M
149 42820 Tonsillectomy and adenoidectomy; younger than age 12 $16.89M
150 A4223 Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) $16.82M
151 70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences $16.76M
152 D2393 Resin-based composite - three surfaces, posterior, primary or permanent $16.69M
153 H2020 Therapeutic behavioral services, per diem $15.95M
154 J2350 Injection, ocrelizumab, 1 mg $15.94M
155 87636 Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B $15.94M
156 H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) $15.93M
157 D0274 Bitewings - four radiographic images $15.91M
158 99281 Emergency department visit for the evaluation and management, self-limited or minor $15.53M
159 77067 Screening mammography, bilateral, including computer-aided detection $15.47M
160 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete $15.31M
161 96415 $15.18M
162 Q3014 Telehealth originating site facility fee $14.89M
163 J0887 Injection, epoetin beta, 1 microgram, (for esrd on dialysis) $14.71M
164 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 $14.52M
165 11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm $14.18M
166 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up $14.18M
167 D4341 $13.54M
168 D0999 Unspecified diagnostic procedure, by report $13.34M
169 87661 Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe $13.11M
170 E1161 Manual adult size wheelchair, includes tilt in space $13.11M
171 96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance $12.91M
172 99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) $12.58M
173 H2019 Therapeutic behavioral services, per 15 minutes $12.47M
174 77412 $12.45M
175 92508 Group treatment of speech, language, voice, communication, and/or auditory processing disorder $12.42M
176 70551 Magnetic resonance imaging, brain; without contrast material $12.37M
177 83036 Hemoglobin; glycosylated (A1C) $12.17M
178 71045 Radiologic examination, chest; single view $12.02M
179 81420 Fetal chromosomal aneuploidy genomic sequence analysis panel $11.99M
180 D2929 $11.92M
181 T2022 Case management, per month $11.90M
182 87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies $11.88M
183 B4087 Gastrostomy/jejunostomy tube, standard, any material, any type, each $11.58M
184 82075 $11.39M
185 92015 Determination of refractive state $11.34M
186 E0784 External ambulatory infusion pump, insulin $11.26M
187 92340 Fitting of spectacles, except for aphakia; monofocal $11.07M
188 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report $11.04M
189 D5120 $11.02M
190 D0230 Intraoral - periapical each additional radiographic image $10.89M
191 T4524 Adult sized disposable incontinence product, brief/diaper, extra large, each $10.82M
192 G0299 Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes $10.61M
193 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation $10.56M
194 87624 Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types $10.54M
195 90686 $10.50M
196 88175 Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer $10.46M
197 G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes $10.38M
198 99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward $10.29M
199 T4523 Adult sized disposable incontinence product, brief/diaper, large, each $10.23M
200 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia $10.14M