| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
596 |
553 |
$109K |
| 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 |
325 |
188 |
$79K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
28 |
25 |
$12K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
12 |
12 |
$1K |
| J7121 |
5% dextrose in lactated ringers infusion, up to 1000 cc |
13 |
13 |
$334.68 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
113 |
66 |
$0.00 |
| A9270 |
Non-covered item or service |
212 |
122 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
102 |
69 |
$0.00 |
| J2704 |
Injection, propofol, 10 mg |
176 |
84 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
45 |
41 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
28 |
12 |
$0.00 |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
12 |
12 |
$0.00 |