| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
8,357 |
8,323 |
$6.65M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
645 |
641 |
$658K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
205 |
205 |
$333K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
604 |
309 |
$315K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
736 |
612 |
$282K |
| 64483 |
|
799 |
600 |
$214K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
467 |
466 |
$185K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
300 |
299 |
$130K |
| D1120 |
Prophylaxis - child |
753 |
752 |
$111K |
| D1351 |
Sealant - per tooth |
175 |
174 |
$80K |
| L8699 |
Prosthetic implant, not otherwise specified |
652 |
630 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
164 |
$56K |
| D1206 |
Topical application of fluoride varnish |
660 |
660 |
$38K |
| D0240 |
|
111 |
111 |
$30K |
| A4649 |
Surgical supply; miscellaneous |
771 |
754 |
$26K |
| 54161 |
|
14 |
14 |
$17K |
| D0272 |
Bitewings - two radiographic images |
113 |
113 |
$15K |
| 30520 |
|
12 |
12 |
$10K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
25 |
25 |
$9K |
| D2330 |
|
27 |
26 |
$8K |
| D2390 |
|
12 |
12 |
$2K |
| D2740 |
Crown - porcelain/ceramic |
24 |
24 |
$1K |
| V2632 |
Posterior chamber intraocular lens |
170 |
147 |
$32.50 |
| 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 |
28 |
27 |
$0.00 |