| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,006 |
3,789 |
$4.55M |
| D9420 |
|
8,028 |
7,229 |
$3.78M |
| D7140 |
Extraction, erupted tooth or exposed root |
6,762 |
3,011 |
$1.53M |
| D2335 |
|
3,277 |
1,624 |
$1.13M |
| D0220 |
Intraoral - periapical first radiographic image |
1,927 |
1,748 |
$574K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,828 |
637 |
$572K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
1,242 |
937 |
$433K |
| D7310 |
|
1,105 |
288 |
$425K |
| D0272 |
Bitewings - two radiographic images |
4,588 |
3,937 |
$424K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,232 |
1,309 |
$389K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
632 |
545 |
$188K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,946 |
1,709 |
$184K |
| D1351 |
Sealant - per tooth |
1,452 |
620 |
$151K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,188 |
1,034 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
525 |
323 |
$110K |
| D1510 |
|
1,548 |
1,070 |
$102K |
| D7230 |
|
53 |
33 |
$35K |
| D2330 |
|
333 |
239 |
$30K |
| D7311 |
|
56 |
37 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,226 |
1,069 |
$14K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
13 |
13 |
$11K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
30 |
12 |
$5K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
14 |
12 |
$4K |
| G8907 |
Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility |
281 |
222 |
$0.00 |
| G8918 |
Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis |
12 |
12 |
$0.00 |