#1288 of 11K

D0160

HCPCS Procedure Code

HCPCS code D0160 is the #1,288 most-billed Medicaid procedure code, with $29.0M in payments across 695K claims from 2018–2024. The national median cost per claim is $34.71. Costs vary widely — the 90th percentile is $72.24 per claim, 2.1× the median.

Total Paid

$29.0M

0.00% of all spending

Total Claims

695K

Providers

883

Avg Cost/Claim

$42

National Cost Distribution

How much do providers bill per claim for D0160? Based on 850 providers billing this code nationally.

Median

$34.71

Average

$44.73

Std Dev

$62.39

Max

$1,232.57

Percentile Distribution (Cost per Claim)

p10

$13.88

p25

$19.72

Median

$34.71

p75

$57.71

p90

$72.24

p95

$91.93

p99

$281.12

50% of providers bill between $19.72 and $57.71 per claim for this code.

90% bill between $13.88 and $72.24.

Top 1% bill above $281.12.

About This Procedure

HCPCS code D0160 was billed by 883 providers across 695K claims, totaling $29.0M in Medicaid payments from 2018–2024. This code was used for 651K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$34.71

Providers Billing

850

National Spending

$29.0M

Avg/Median Ratio

1.29×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for D0160

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1952345431	$1.5M	$435.28	12.5× median	Top 1%
2	1124353248	$1.1M	$29.91	0.9× median	Below Median
3	1205804663	$1.0M	$84.56	2.4× median	Top 10%
4	1821339086	$771K	$28.70	0.8× median	Below Median
5	1346473279	$592K	$67.72	2.0× median	Above 75th
6	1588729362	$527K	$61.82	1.8× median	Above 75th
7	1477690816	$508K	$1,232.57	35.5× median	Top 1%
8	1881984920	$425K	$34.95	1.0× median	Above Median
9	1942212030	$375K	$30.18	0.9× median	Below Median
10	1093835217	$366K	$463.47	13.4× median	Top 1%
11	1528553070	$357K	$70.39	2.0× median	Above 75th
12	1124106687	$311K	$42.21	1.2× median	Above Median
13	1942589908	$304K	$40.93	1.2× median	Above Median
14	1790987543	$300K	$418.38	12.1× median	Top 1%
15	1689786170	$294K	$36.00	1.0× median	Above Median
16	Department Of Intellectual And Developmental Disabilities, State Of Tn Nashville, TN · Public Health or Welfare	$290K	$41.96	1.2× median	Above Median
17	1619973070	$281K	$140.85	4.1× median	Top 10%
18	1164814042	$275K	$36.39	1.0× median	Above Median
19	1871803817	$254K	$247.99	7.1× median	Top 10%
20	1508005984	$237K	$34.44	1.0× median	Below Median

Showing top 20 of 883 providers billing this code

Related Procedures

D0150Comprehensive oral evaluation, new or established patient$1.76B D0170$4.2M

← All procedures Top providers →