#6226 of 11K

D9986

HCPCS Procedure Code

HCPCS code D9986 is the #6,226 most-billed Medicaid procedure code, with $82K in payments across 319K claims from 2018–2024. The national median cost per claim is $1.04. Costs vary widely — the 90th percentile is $20.00 per claim, 19.2× the median.

Total Paid

$82K

0.00% of all spending

Total Claims

319K

Providers

710

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for D9986? Based on 87 providers billing this code nationally.

Median

$1.04

Average

$5.57

Std Dev

$12.46

Max

$68.75

Percentile Distribution (Cost per Claim)

p10

$0.11

p25

$0.25

Median

$1.04

p75

$2.84

p90

$20.00

p95

$28.30

p99

$57.66

50% of providers bill between $0.25 and $2.84 per claim for this code.

90% bill between $0.11 and $20.00.

Top 1% bill above $57.66.

About This Procedure

HCPCS code D9986 was billed by 710 providers across 319K claims, totaling $82K in Medicaid payments from 2018–2024. This code was used for 295K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$1.04

Providers Billing

National Spending

$82K

Avg/Median Ratio

5.36×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for D9986

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1083073050	$26K	$51.05	49.1× median	Top 10%
2	1992850689	$13K	$31.85	30.6× median	Top 10%
3	1083067482	$6K	$1.01	1.0× median	Below Median
4	1215614532	$5K	$19.28	18.5× median	Above 75th
5	1497020119	$4K	$55.86	53.7× median	Top 10%
6	1740352608	$3K	$20.00	19.2× median	Top 10%
7	1770827834	$2K	$1.18	1.1× median	Above Median
8	1740692938	$2K	$2.96	2.8× median	Above 75th
9	1659496917	$2K	$2.85	2.7× median	Above 75th
10	Arrow Dental Pllc Lexington, KY · Dentist Orthodontics and Dentofacial Orthopedics	$1K	$0.39	0.4× median	Below Median
11	1972854149	$1K	$0.74	0.7× median	Below Median
12	1356469282	$1K	$2.67	2.6× median	Above Median
13	1265805717	$966	$0.63	0.6× median	Below Median
14	1760633341	$825	$68.75	66.1× median	Top 1%
15	1093833923	$798	$2.77	2.7× median	Above Median
16	1548259377	$642	$2.88	2.8× median	Above 75th
17	1417464157	$640	$19.39	18.6× median	Above 75th
18	1790075166	$621	$0.54	0.5× median	Below Median
19	1477058659	$615	$0.68	0.7× median	Below Median
20	1003028036	$603	$2.80	2.7× median	Above Median

Showing top 20 of 710 providers billing this code

Related Procedures

D9993$89.2M D9996$4.1M D9995$4.0M D9990$2.4M D9994$1.8M

← All procedures Top providers →