| 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 |
5,449 |
4,056 |
$7.21M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
9,218 |
8,980 |
$3.41M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,497 |
4,072 |
$1.55M |
| D1120 |
Prophylaxis - child |
1,828 |
1,490 |
$786K |
| D9222 |
|
9,216 |
8,981 |
$671K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,940 |
1,451 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,263 |
1,648 |
$120K |
| D2330 |
|
1,564 |
1,133 |
$93K |
| D1351 |
Sealant - per tooth |
2,659 |
1,972 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,098 |
2,260 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,760 |
2,022 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,172 |
1,033 |
$31K |
| D2332 |
|
879 |
585 |
$30K |
| D2331 |
|
489 |
325 |
$19K |
| D2929 |
|
785 |
559 |
$12K |
| D2933 |
|
434 |
282 |
$10K |
| D2932 |
|
217 |
183 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
173 |
108 |
$4K |
| D2335 |
|
53 |
40 |
$780.06 |
| D1510 |
|
850 |
534 |
$0.00 |
| D1354 |
|
32 |
25 |
$0.00 |
| D3230 |
|
138 |
83 |
$0.00 |