| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
873 |
808 |
$858K |
| 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 |
74 |
73 |
$68K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
15 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
75 |
75 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
29 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
120 |
27 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
245 |
76 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
70 |
69 |
$0.00 |