#1125 of 11K

D4342

HCPCS Procedure Code

HCPCS code D4342 is the #1,125 most-billed Medicaid procedure code, with $39.2M in payments across 641K claims from 2018–2024. The national median cost per claim is $42.00. Costs vary widely — the 90th percentile is $111.33 per claim, 2.7× the median.

Total Paid

$39.2M

0.00% of all spending

Total Claims

641K

Providers

Avg Cost/Claim

$61

National Cost Distribution

How much do providers bill per claim for D4342? Based on 1K providers billing this code nationally.

Median

$42.00

Average

$63.02

Std Dev

$40.63

Max

$546.93

Percentile Distribution (Cost per Claim)

p10

$25.06

p25

$41.64

Median

$42.00

p75

$88.30

p90

$111.33

p95

$136.20

p99

$189.77

50% of providers bill between $41.64 and $88.30 per claim for this code.

90% bill between $25.06 and $111.33.

Top 1% bill above $189.77.

About This Procedure

HCPCS code D4342 was billed by 1K providers across 641K claims, totaling $39.2M in Medicaid payments from 2018–2024. This code was used for 262K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$42.00

Providers Billing

National Spending

$39.2M

Avg/Median Ratio

1.50×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for D4342

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1437168341	$868K	$76.56	1.8× median	Above Median
2	1740584226	$853K	$79.79	1.9× median	Above Median
3	1649339581	$760K	$75.23	1.8× median	Above Median
4	1396292405	$658K	$89.66	2.1× median	Above 75th
5	1649679762	$658K	$41.79	1.0× median	Below Median
6	1184934903	$637K	$95.74	2.3× median	Above 75th
7	Department Of Intellectual And Developmental Disabilities, State Of Tn Nashville, TN · Public Health or Welfare	$508K	$110.04	2.6× median	Above 75th
8	1124164926	$498K	$80.63	1.9× median	Above Median
9	1801283106	$495K	$102.64	2.4× median	Above 75th
10	1952708877	$450K	$136.13	3.2× median	Top 10%
11	1841590114	$442K	$132.22	3.1× median	Top 10%
12	1700322799	$434K	$92.92	2.2× median	Above 75th
13	1780924613	$434K	$98.91	2.4× median	Above 75th
14	1912430778	$402K	$41.59	1.0× median	Below Median
15	1003200890	$385K	$82.21	2.0× median	Above Median
16	1952654790	$385K	$90.54	2.2× median	Above 75th
17	1407168792	$377K	$116.21	2.8× median	Top 10%
18	1114454287	$357K	$67.41	1.6× median	Above Median
19	1124460126	$354K	$202.78	4.8× median	Top 1%
20	1003354911	$334K	$100.54	2.4× median	Above 75th

Showing top 20 of 1K providers billing this code

Related Procedures

D4341Periodontal scaling, per quadrant$228.6M D4346$14.7M

← All procedures Top providers →