| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9420 |
|
5,393 |
4,712 |
$410K |
| D2140 |
|
4,357 |
1,485 |
$229K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,533 |
1,025 |
$197K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,571 |
2,567 |
$155K |
| 0360 |
|
1,767 |
1,739 |
$144K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
2,266 |
2,165 |
$139K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,911 |
924 |
$124K |
| D1110 |
Prophylaxis - adult |
1,041 |
1,037 |
$76K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
1,835 |
1,747 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,475 |
1,467 |
$64K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
100 |
75 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,859 |
1,287 |
$40K |
| D2931 |
|
331 |
223 |
$39K |
| D2330 |
|
472 |
210 |
$35K |
| D3221 |
|
563 |
340 |
$35K |
| D0350 |
|
1,985 |
1,374 |
$29K |
| 0490 |
|
680 |
670 |
$26K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,911 |
1,801 |
$24K |
| 0710 |
|
1,554 |
1,531 |
$23K |
| 0160 |
|
824 |
813 |
$23K |
| D1120 |
Prophylaxis - child |
1,049 |
1,049 |
$23K |
| 0760 |
|
962 |
952 |
$20K |
| D0330 |
Panoramic radiographic image |
692 |
692 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
375 |
374 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,103 |
2,099 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
143 |
69 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,411 |
1,409 |
$16K |
| D9920 |
|
322 |
321 |
$15K |
| D7240 |
Removal of impacted tooth - completely bony |
64 |
32 |
$15K |
| D3310 |
|
50 |
24 |
$14K |
| J2704 |
Injection, propofol, 10 mg |
1,712 |
1,650 |
$13K |
| D9430 |
|
306 |
294 |
$10K |
| 0761 |
|
504 |
496 |
$9K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
2,002 |
1,932 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
48 |
12 |
$5K |
| D7230 |
|
26 |
14 |
$5K |
| A4217 |
Sterile water/saline, 500 ml |
829 |
822 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
53 |
26 |
$3K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
691 |
646 |
$2K |
| D2940 |
|
32 |
12 |
$2K |
| D2331 |
|
20 |
13 |
$2K |
| D9993 |
|
66 |
66 |
$1K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
60 |
58 |
$803.78 |
| D1310 |
|
66 |
66 |
$782.00 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
104 |
103 |
$777.71 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
283 |
280 |
$724.10 |
| D1351 |
Sealant - per tooth |
32 |
13 |
$660.00 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
126 |
125 |
$334.72 |
| A6404 |
Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
175 |
173 |
$327.39 |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
145 |
143 |
$315.01 |
| A4245 |
Alcohol wipes, per box |
190 |
188 |
$291.19 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
88 |
87 |
$280.38 |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
150 |
148 |
$280.33 |
| S1015 |
Iv tubing extension set |
129 |
126 |
$232.50 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
174 |
172 |
$231.71 |
| A6455 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard |
180 |
178 |
$166.42 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
103 |
102 |
$162.59 |
| A4649 |
Surgical supply; miscellaneous |
108 |
108 |
$150.00 |
| E1399 |
Durable medical equipment, miscellaneous |
129 |
127 |
$142.51 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
18 |
18 |
$139.07 |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
15 |
15 |
$137.65 |
| A6025 |
Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each |
99 |
97 |
$132.68 |
| E0425 |
Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
129 |
127 |
$127.51 |
| A4618 |
Breathing circuits |
124 |
122 |
$112.50 |
| D0603 |
|
28 |
28 |
$105.00 |
| J3490 |
Unclassified drugs |
134 |
114 |
$99.00 |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
167 |
166 |
$79.48 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
150 |
147 |
$75.78 |
| A4928 |
Surgical mask, per 20 |
119 |
117 |
$69.00 |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
135 |
133 |
$45.07 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
58 |
55 |
$37.09 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
31 |
31 |
$27.36 |
| A4215 |
Needle, sterile, any size, each |
134 |
132 |
$17.74 |
| A4332 |
Lubricant, individual sterile packet, each |
124 |
122 |
$12.12 |
| A4619 |
Face tent |
29 |
27 |
$8.59 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
115 |
113 |
$0.01 |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
103 |
101 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
14 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |
| A7030 |
Full face mask used with positive airway pressure device, each |
13 |
13 |
$0.00 |