Hercules Medicaid providers submitted $327,911 in claims for Dental Services in 2024, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This total was 8.2% higher than the $303,189 recorded in 2023 for the same type of service.
Medicaid is managed by states and funded jointly by state and federal governments. It provides health insurance for low-income people and families, children, seniors, and individuals with disabilities, making it a substantial component of the nation’s healthcare system.
Taxpayers support Medicaid payments, so changing billing levels reflect how public healthcare resources are distributed within a community.
The “Dental Services” category contains a group of Medicaid-billed services identified by care type, using standard HCPCS and CPT code groupings. This analysis assigned each billing code to a single service category with consistent prefixes and code ranges, enabling aggregation and accurate year-over-year comparison while preventing double counting.
Dental Services had the highest total Medicaid payment among service categories in Hercules in 2024 as spending rose throughout several categories.
Statewide in California, Dental Services ranked 11th for total Medicaid payments in 2024.
Between 2019 and 2024, Hercules saw Medicaid-related Dental Services spending increase by $221,291 or 207.6%. Spending growth intensified during certain years, with significant annual jumps seen in both 2022 and 2021.
Although Dental Services payments were distributed citywide, the majority occurred within specific ZIP codes. The ZIP code 94547 accounted for the full $327,911 in Dental Services Medicaid payments in 2024, representing 100% of those payments for Hercules that year.
Most Medicaid Dental Services payments in Hercules were concentrated among a relatively small range of individual billing codes.
From 2023 to 2024, Dental Services Medicaid payments in Hercules rose by 8.2%. In comparison, payments for all Medicaid claim categories citywide changed by 22% during that period.
According to the Centers for Medicare & Medicaid Services, federal and state Medicaid spending combined totaled about $871.7 billion in fiscal year 2023, constituting roughly 18% of overall national health expenditures and rising sharply from an estimated $613.5 billion in 2019, prior to the COVID-19 pandemic.
This increase marks a roughly 40% rise in just a few years, driven by expanded enrollment and increased care usage during and after the pandemic period.
Recent federal budget measures implemented under the Trump administration brought notable proposals that would reduce federal Medicaid support and alter the program’s structure. The “One Big Beautiful Bill Act,” enacted in 2025, is set to cut over $1 trillion in federal Medicaid spending over the coming decade, introducing provisions including work requirements and higher cost-sharing. These changes are projected to reduce funding and coverage for certain beneficiaries, shift more costs onto states, and restrict the federal Medicaid funding growth, while the program continues serving tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $106,619 | -44.8% |
| 2021 | $165,836 | 55.5% |
| 2022 | $270,749 | 63.3% |
| 2023 | $303,188 | 12% |
| 2024 | $327,911 | 8.2% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Dental Services | $327,911 | 60.6% |
| 2 | Evaluation and Management | $193,453 | 35.8% |
| 3 | Medicine Services and Procedures | $16,564 | 3.1% |
| 4 | Pathology and Laboratory Procedures | $2,958 | 0.5% |
| 5 | Surgery | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| D0120 | Periodic oral evaluation | $171,241 | 18 |
| D0145 | Oral evaluation, pt < 3yrs | $35,722 | 13 |
| D0150 | Comprehensve oral evaluation | $35,309 | 12 |
| D0230 | Intraoral periapical ea add | $26,786 | 18 |
| D0272 | Dental bitewings two images | $19,056 | 16 |
| D0603 | Caries risk assess high risk | $13,748 | 13 |
| D0274 | Bitewings four images | $9,028 | 13 |
| D0601 | Caries risk assess low risk | $6,120 | 13 |
| D0220 | Intraoral periapical first | $5,454 | 12 |
| D0602 | Caries risk assess mod risk | $5,445 | 12 |
Note: HCPCS codes are shown for context within the category. Category totals and rankings in this article are based on standardized service groupings rather than individual billing codes.
Information in this article was obtained from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The source data can be found here.
