#2014 of 11K

D1355

HCPCS Procedure Code

HCPCS code D1355 is the #2,014 most-billed Medicaid procedure code, with $10.1M in payments across 513K claims from 2018–2024. The national median cost per claim is $19.66. Costs vary widely — the 90th percentile is $71.93 per claim, 3.7× the median.

Total Paid

$10.1M

0.00% of all spending

Total Claims

513K

Providers

108

Avg Cost/Claim

$20

National Cost Distribution

How much do providers bill per claim for D1355? Based on 75 providers billing this code nationally.

Median

$19.66

Average

$26.77

Std Dev

$25.35

Max

$92.60

Percentile Distribution (Cost per Claim)

p10

$1.37

p25

$5.49

Median

$19.66

p75

$33.99

p90

$71.93

p95

$81.69

p99

$87.98

50% of providers bill between $5.49 and $33.99 per claim for this code.

90% bill between $1.37 and $71.93.

Top 1% bill above $87.98.

About This Procedure

HCPCS code D1355 was billed by 108 providers across 513K claims, totaling $10.1M in Medicaid payments from 2018–2024. This code was used for 67K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$19.66

Providers Billing

National Spending

$10.1M

Avg/Median Ratio

1.36×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for D1355

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Jessica Marn Dds Dental Outreach Pllc Toledo, OH · Dentist	$6.7M	$92.60	4.7× median	Top 1%
2	1871028159	$453K	$11.61	0.6× median	Below Median
3	1225282262	$429K	$30.32	1.5× median	Above Median
4	1801981865	$422K	$86.36	4.4× median	Top 10%
5	1174576375	$358K	$34.18	1.7× median	Above 75th
6	1043336712	$233K	$73.09	3.7× median	Top 10%
7	1265202717	$189K	$50.26	2.6× median	Above 75th
8	1043410095	$149K	$12.69	0.6× median	Below Median
9	1831367192	$134K	$75.23	3.8× median	Top 10%
10	1124877147	$88K	$20.31	1.0× median	Above Median
11	1144609702	$79K	$32.43	1.6× median	Above Median
12	1861023251	$77K	$33.80	1.7× median	Above Median
13	1508815747	$62K	$22.84	1.2× median	Above Median
14	1386727410	$59K	$32.00	1.6× median	Above Median
15	1235839077	$54K	$18.78	1.0× median	Below Median
16	1669607644	$45K	$19.72	1.0× median	Above Median
17	1245752534	$44K	$58.49	3.0× median	Above 75th
18	1871282061	$42K	$51.34	2.6× median	Above 75th
19	1659939346	$41K	$73.73	3.8× median	Top 10%
20	1851694996	$41K	$19.05	1.0× median	Below Median

Showing top 20 of 108 providers billing this code

Related Procedures

D1351Sealant, per tooth$1.60B D1354$128.8M D1353$7.0M D1352$2.9M

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