Guam Medicaid Reimbursement Rates
What Medicaid pays for medical procedures and services in Guam, based on 2024 claims data.
2024 Overview
Procedures
263
Total Claims
229.4K
Total Paid
$20.9M
Popular Services
Procedures
Showing 1–50 of 263 procedures, sorted by most claims.
| HCPCS Code | Description | Total Claims | Avg Payment | Min Payment | Max Payment |
|---|---|---|---|---|---|
| 90999 | Unlisted dialysis procedure | 27,719 | $98.17 | $68.76 | $133.95 |
| 99213 | Office o/p est low 20 min | 18,471 | $79.06 | $0.00 | $96.35 |
| D0230 | Intraoral periapical ea add | 17,441 | $14.08 | $11.00 | $49.85 |
| 99214 | Office o/p est mod 30 min | 11,811 | $100.28 | $0.00 | $134.99 |
| D0220 | Intraoral periapical first | 8,043 | $14.65 | $13.13 | $15.00 |
| D3120 | Pulp cap indirect | 7,837 | $45.28 | $38.22 | $143.83 |
| D1120 | Dental prophylaxis child | 7,380 | $58.90 | $52.50 | $60.00 |
| D2150 | Amalgam two surfaces permane | 5,768 | $95.50 | $79.20 | $252.00 |
| D0150 | Comprehensve oral evaluation | 5,380 | $74.77 | $63.80 | $77.00 |
| D1351 | Dental sealant per tooth | 5,166 | $38.01 | $26.67 | $244.71 |
| D3220 | Therapeutic pulpotomy | 4,900 | $102.69 | $94.81 | $222.22 |
| 99284 | Emergency dept visit mod mdm | 4,709 | $372.38 | $65.56 | $754.74 |
| 90460 | Im admin 1st/only component | 4,682 | $24.24 | $22.74 | $26.09 |
| D0120 | Periodic oral evaluation | 4,541 | $40.48 | $20.13 | $43.00 |
| D2930 | Prefab stnlss steel crwn pri | 4,057 | $170.56 | $148.93 | $556.50 |
| 93010 | Electrocardiogram report | 3,406 | $7.59 | $1.04 | $15.22 |
| 99283 | Emergency dept visit low mdm | 3,281 | $576.39 | $18.07 | $1,075.00 |
| D7140 | Extraction erupted tooth/exr | 3,045 | $156.40 | $140.63 | $277.50 |
| 90461 | Im admin each addl component | 2,839 | $23.02 | $16.42 | $29.40 |
| 86580 | Tb intradermal test | 2,571 | $10.92 | $9.05 | $11.66 |
| D2140 | Amalgam one surface permanen | 2,538 | $70.19 | $55.00 | $151.67 |
| D0274 | Bitewings four images | 2,524 | $34.41 | $27.43 | $36.00 |
| D9230 | Analgesia | 2,380 | $34.99 | $29.62 | $51.58 |
| 99211 | Off/op est may x req phy/qhp | 2,378 | $24.61 | $21.34 | $25.68 |
| 99233 | Sbsq hosp ip/obs high 50 | 2,181 | $91.44 | $57.36 | $119.87 |
| G0463 | Hospital outpt clinic visit | 2,024 | $272.68 | $124.92 | $421.79 |
| D0140 | Limit oral eval problm focus | 1,988 | $65.98 | $57.43 | $67.00 |
| 85025 | Complete cbc w/auto diff wbc | 1,949 | $48.67 | $7.77 | $61.10 |
| D2940 | Place direct restoration | 1,921 | $346.43 | $59.80 | $762.35 |
| D2160 | Amalgam three surfaces perma | 1,849 | $108.00 | $97.38 | $162.00 |
| 71045 | X-ray exam chest 1 view | 1,781 | $20.48 | $0.00 | $184.55 |
| D1110 | Dental prophylaxis adult | 1,749 | $50.45 | $26.00 | $52.00 |
| D0272 | Dental bitewings two images | 1,474 | $24.75 | $23.89 | $25.00 |
| 80048 | Basic metabolic pnl total ca | 1,448 | $163.70 | $8.46 | $197.94 |
| 99212 | Office o/p est sf 10 min | 1,390 | $54.46 | $22.06 | $60.37 |
| 93005 | Electrocardiogram tracing | 1,356 | $106.19 | $2.98 | $282.47 |
| 99232 | Sbsq hosp ip/obs moderate 35 | 1,305 | $94.85 | $34.02 | $439.89 |
| 93306 | Tte w/doppler complete | 1,291 | $94.88 | $3.77 | $633.57 |
| A0429 | Bls-emergency | 1,291 | $118.11 | $108.14 | $124.72 |
| 71046 | X-ray exam chest 2 views | 1,190 | $63.86 | $5.51 | $326.47 |
| 90471 | Immunization admin | 1,130 | $20.12 | $2.62 | $22.67 |
| D2332 | Resin three surfaces-anterio | 1,100 | $127.28 | $110.50 | $130.00 |
| D2335 | Resin 4/> surf or w incis an | 1,096 | $158.09 | $127.56 | $164.00 |
| 99203 | Office o/p new low 30 min | 1,068 | $108.62 | $57.10 | $117.06 |
| D9310 | Dental consultation | 883 | $64.80 | $55.71 | $65.00 |
| 99282 | Emergency dept visit sf mdm | 882 | $485.16 | $29.47 | $754.76 |
| 92014 | Compre oph exam est pt 1/> | 865 | $86.30 | $41.96 | $136.37 |
| 99393 | Prev visit est age 5-11 | 787 | $104.97 | $85.66 | $110.14 |
| D0210 | Intraor comprehensive series | 758 | $73.60 | $62.03 | $77.00 |
| 81001 | Urinalysis auto w/scope | 710 | $18.93 | $13.02 | $22.14 |