#5325 of 11K

D5421

HCPCS Procedure Code

HCPCS code D5421 is the #5,325 most-billed Medicaid procedure code, with $228K in payments across 7,329 claims from 2018–2024. The national median cost per claim is $31.65.

Total Paid

$228K

0.00% of all spending

Total Claims

7,329

Providers

Avg Cost/Claim

$31

National Cost Distribution

How much do providers bill per claim for D5421? Based on 34 providers billing this code nationally.

Median

$31.65

Average

$28.33

Std Dev

$12.36

Max

$56.84

Percentile Distribution (Cost per Claim)

p10

$9.50

p25

$20.92

Median

$31.65

p75

$35.00

p90

$39.61

p95

$41.16

p99

$52.12

50% of providers bill between $20.92 and $35.00 per claim for this code.

90% bill between $9.50 and $39.61.

Top 1% bill above $52.12.

About This Procedure

HCPCS code D5421 was billed by 35 providers across 7,329 claims, totaling $228K in Medicaid payments from 2018–2024. This code was used for 6,388 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$31.65

Providers Billing

National Spending

$228K

Avg/Median Ratio

0.90×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for D5421

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	My Community Dental Centers Inc Petoskey, MI · Dentist, Dental Public Health	$36K	$42.54	1.3× median	Top 10%
2	1073679189	$33K	$34.84	1.1× median	Above Median
3	1407146111	$26K	$33.06	1.0× median	Above Median
4	1710036181	$26K	$32.89	1.0× median	Above Median
5	1912430778	$25K	$34.81	1.1× median	Above Median
6	1437584349	$19K	$29.65	0.9× median	Below Median
7	1699028597	$11K	$38.95	1.2× median	Above 75th
8	1447441720	$10K	$39.90	1.3× median	Top 10%
9	1942717343	$8K	$31.92	1.0× median	Above Median
10	1477678134	$6K	$29.22	0.9× median	Below Median
11	1699006296	$4K	$15.00	0.5× median	Below Median
12	1548779135	$3K	$37.50	1.2× median	Above 75th
13	1932552080	$3K	$38.10	1.2× median	Above 75th
14	1811137813	$3K	$31.38	1.0× median	Below Median
15	1902959901	$2K	$35.00	1.1× median	Above 75th
16	1366692824	$2K	$56.84	1.8× median	Top 1%
17	1134420110	$2K	$40.42	1.3× median	Top 10%
18	1407412992	$1K	$38.91	1.2× median	Above 75th
19	1194343335	$1K	$25.10	0.8× median	Below Median
20	1689947269	$1K	$28.08	0.9× median	Below Median

Showing top 20 of 35 providers billing this code

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