| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
1,583 |
1,446 |
$801K |
| 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 |
651 |
582 |
$619K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
327 |
212 |
$160K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
61 |
53 |
$41K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
166 |
127 |
$26K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
61 |
52 |
$13K |
| 64493 |
|
63 |
26 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
206 |
194 |
$720.22 |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
49 |
$685.75 |
| 45381 |
|
13 |
12 |
$549.90 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
645 |
543 |
$382.36 |
| 82948 |
|
281 |
234 |
$0.00 |
| 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 |
801 |
645 |
$0.00 |
| D2934 |
|
75 |
27 |
$0.00 |
| D1120 |
Prophylaxis - child |
230 |
217 |
$0.00 |
| G8918 |
Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis |
253 |
216 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
527 |
194 |
$0.00 |
| D2330 |
|
61 |
53 |
$0.00 |
| L8699 |
Prosthetic implant, not otherwise specified |
189 |
148 |
$0.00 |
| D1351 |
Sealant - per tooth |
119 |
54 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
96 |
65 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
230 |
217 |
$0.00 |
| G8916 |
Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time |
57 |
43 |
$0.00 |
| D2390 |
|
29 |
12 |
$0.00 |