South Dakota Medicaid Reimbursement Rates
What Medicaid pays for medical procedures and services in South Dakota, based on 2024 claims data.
2024 Overview
Procedures
1.1K
Total Claims
3.9M
Total Paid
$498.7M
Popular Services
Procedures
Showing 51–100 of 1,069 procedures, sorted by most claims.
| HCPCS Code | Description | Total Claims | Avg Payment | Min Payment | Max Payment |
|---|---|---|---|---|---|
| D0230 | Intraoral periapical ea add | 18,117 | $17.57 | $0.00 | $57.52 |
| 99233 | Sbsq hosp ip/obs high 50 | 17,568 | $65.52 | $25.36 | $102.12 |
| D1110 | Dental prophylaxis adult | 17,273 | $70.06 | $0.00 | $454.11 |
| A0130 | Noner transport wheelch van | 17,178 | $40.98 | $21.60 | $46.44 |
| 99215 | Office o/p est hi 40 min | 17,091 | $129.72 | $18.60 | $688.74 |
| 71046 | X-ray exam chest 2 views | 16,030 | $12.52 | $0.00 | $44.94 |
| 90472 | Immunization admin each add | 15,753 | $15.88 | $0.00 | $41.92 |
| 99204 | Office o/p new mod 45 min | 15,031 | $93.18 | $4.78 | $166.07 |
| D7140 | Extraction erupted tooth/exr | 14,597 | $121.68 | $0.00 | $416.26 |
| 99212 | Office o/p est sf 10 min | 14,410 | $195.45 | $4.85 | $719.00 |
| H0015 | Alcohol and/or drug services | 14,360 | $162.93 | $53.37 | $787.35 |
| D0220 | Intraoral periapical first | 14,336 | $37.87 | $0.00 | $487.06 |
| D0272 | Dental bitewings two images | 13,388 | $35.03 | $0.00 | $42.64 |
| 97140 | Manual therapy 1/> regions | 13,323 | $16.59 | $6.85 | $35.22 |
| H0005 | Alcohol and/or drug services | 13,042 | $97.76 | $31.61 | $510.59 |
| 99391 | Per pm reeval est pat infant | 12,824 | $98.87 | $45.95 | $719.00 |
| 93005 | Electrocardiogram tracing | 12,732 | $14.67 | $0.00 | $47.18 |
| D2930 | Prefab stnlss steel crwn pri | 12,548 | $210.50 | $69.63 | $238.85 |
| 83036 | Hemoglobin glycosylated a1c | 12,516 | $7.02 | $0.00 | $95.87 |
| 80061 | Lipid panel | 12,239 | $9.87 | $0.00 | $119.83 |
| 92004 | Compre oph exam new pt 1/> | 12,116 | $122.02 | $29.41 | $179.75 |
| 90863 | Pharmacologic mgmt w/psytx | 12,067 | $129.21 | $24.27 | $250.96 |
| T2017 | Habil res waiver 15 min | 11,727 | $261.55 | $65.70 | $1,473.26 |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or | 11,295 | $68.57 | $27.80 | $125.06 |
| 90853 | Group psychotherapy | 11,169 | $35.67 | $0.00 | $162.68 |
| 90656 | Iiv3 vacc no prsv 0.5 ml im | 11,105 | $3.48 | $0.00 | $18.86 |
| S9123 | Nursing care in home rn | 10,950 | $657.95 | $317.81 | $866.48 |
| D1208 | Topical app fluorid ex vrnsh | 10,896 | $32.54 | $22.13 | $34.02 |
| 81001 | Urinalysis auto w/scope | 10,481 | $3.66 | $0.00 | $102.71 |
| 99392 | Prev visit est age 1-4 | 10,345 | $106.03 | $43.93 | $719.00 |
| D2391 | Post 1 srfc resinbased cmpst | 9,817 | $126.09 | $41.73 | $154.31 |
| 88305 | Tissue exam by pathologist | 9,777 | $58.39 | $0.00 | $200.01 |
| 90834 | Psytx w pt 45 minutes | 9,632 | $89.75 | $35.22 | $719.00 |
| 84443 | Assay thyroid stim hormone | 9,543 | $12.81 | $0.00 | $75.68 |
| D0274 | Bitewings four images | 9,196 | $50.86 | $0.00 | $575.20 |
| 87591 | N.gonorrhoeae dna amp prob | 9,167 | $28.01 | $0.00 | $35.22 |
| 87491 | Chlmyd trach dna amp probe | 9,144 | $28.05 | $0.00 | $35.22 |
| 76816 | Ob us follow-up per fetus | 9,124 | $39.22 | $20.34 | $100.81 |
| A0427 | Als1-emergency | 9,007 | $227.41 | $63.72 | $457.27 |
| D0150 | Comprehensve oral evaluation | 8,923 | $71.30 | $0.00 | $564.93 |
| 90460 | Im admin 1st/only component | 8,891 | $37.43 | $0.00 | $63.61 |
| 99239 | Hosp ip/obs dschrg mgmt >30 | 8,874 | $73.08 | $35.84 | $99.08 |
| T1012 | Alcohol/substance abuse skil | 8,746 | $73.11 | $16.46 | $394.80 |
| A4335 | Incontinence supply | 8,611 | $36.20 | $7.80 | $102.03 |
| T2033 | Res, nos waiver per diem | 8,538 | $436.88 | $243.61 | $2,847.37 |
| T2048 | Bh ltc res r&b, per diem | 8,518 | $3,819.92 | $467.59 | $11,816.51 |
| D2392 | Post 2 srfc resinbased cmpst | 8,501 | $150.55 | $49.93 | $253.76 |
| 99223 | 1st hosp ip/obs high 75 | 8,473 | $111.04 | $46.47 | $150.23 |
| V2784 | Lens polycarb or equal | 8,428 | $49.38 | $1.74 | $101.32 |
| 96372 | Ther/proph/diag inj sc/im | 8,420 | $26.43 | $0.00 | $553.08 |