| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
2,546 |
2,266 |
$1.34M |
| G0330 |
Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room |
548 |
411 |
$832K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
1,899 |
1,710 |
$764K |
| 30140 |
|
1,201 |
952 |
$519K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
2,753 |
2,024 |
$465K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,319 |
1,080 |
$422K |
| D1120 |
Prophylaxis - child |
1,692 |
1,363 |
$88K |
| 54161 |
|
132 |
126 |
$54K |
| D1351 |
Sealant - per tooth |
125 |
118 |
$28K |
| 42830 |
|
59 |
57 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
664 |
454 |
$23K |
| 49591 |
|
15 |
14 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
24 |
$581.76 |
| D2140 |
|
12 |
12 |
$581.76 |
| C9290 |
Injection, bupivacaine liposome, 1 mg |
80 |
70 |
$577.50 |
| G8916 |
Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time |
168 |
167 |
$0.00 |
| 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 |
438 |
430 |
$0.00 |
| G8918 |
Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis |
251 |
246 |
$0.00 |