| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
1,210 |
1,069 |
$601K |
| 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 |
189 |
164 |
$172K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
286 |
250 |
$116K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
145 |
84 |
$61K |
| 54300 |
|
96 |
89 |
$39K |
| 17999 |
|
26 |
17 |
$24K |
| 54304 |
|
25 |
24 |
$23K |
| 54161 |
|
46 |
42 |
$8K |
| 67311 |
|
14 |
13 |
$8K |
| 54163 |
|
12 |
12 |
$2K |
| 14040 |
|
13 |
12 |
$886.56 |
| D1206 |
Topical application of fluoride varnish |
41 |
41 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
197 |
38 |
$0.00 |
| 82657 |
|
52 |
29 |
$0.00 |
| L8699 |
Prosthetic implant, not otherwise specified |
48 |
38 |
$0.00 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
14 |
14 |
$0.00 |
| D2933 |
|
311 |
50 |
$0.00 |
| D1120 |
Prophylaxis - child |
41 |
41 |
$0.00 |