| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
1,126 |
1,108 |
$661K |
| T1015 |
Clinic visit/encounter, all-inclusive |
564 |
558 |
$343K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
271 |
269 |
$46K |
| D9420 |
|
206 |
205 |
$18K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
38 |
38 |
$7K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
14 |
13 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
12 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12 |
12 |
$1K |
| 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 |
200 |
162 |
$18.20 |
| D2390 |
|
32 |
32 |
$0.00 |