| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
9,300 |
6,914 |
$13.09M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
15,922 |
15,620 |
$6.74M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,289 |
8,491 |
$2.78M |
| D1120 |
Prophylaxis - child |
5,300 |
4,919 |
$2.26M |
| D9222 |
|
15,907 |
15,606 |
$1.17M |
| D2932 |
|
4,751 |
3,914 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,841 |
2,308 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,042 |
1,672 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,162 |
4,210 |
$39K |
| D1206 |
Topical application of fluoride varnish |
4,885 |
4,508 |
$37K |
| D2330 |
|
2,120 |
1,735 |
$33K |
| D1351 |
Sealant - per tooth |
2,773 |
2,277 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,452 |
3,661 |
$22K |
| D2933 |
|
567 |
541 |
$16K |
| D2332 |
|
472 |
362 |
$7K |
| D1510 |
|
1,500 |
1,184 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
210 |
170 |
$4K |
| D2331 |
|
223 |
160 |
$4K |
| D3230 |
|
1,464 |
1,181 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
57 |
$0.00 |
| D1575 |
|
14 |
14 |
$0.00 |
| D9971 |
|
88 |
88 |
$0.00 |