| 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 |
10,090 |
7,477 |
$12.91M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
17,476 |
17,187 |
$5.89M |
| D1120 |
Prophylaxis - child |
4,579 |
3,539 |
$2.01M |
| D9222 |
|
17,473 |
17,174 |
$1.29M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,826 |
7,705 |
$1.08M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,283 |
4,864 |
$891K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,764 |
2,891 |
$449K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,103 |
5,070 |
$317K |
| D1351 |
Sealant - per tooth |
5,064 |
3,809 |
$298K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,575 |
2,049 |
$294K |
| D2330 |
|
2,369 |
1,783 |
$254K |
| D2332 |
|
1,876 |
1,458 |
$240K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,353 |
4,054 |
$172K |
| D2932 |
|
1,765 |
1,316 |
$72K |
| D2331 |
|
727 |
497 |
$45K |
| D1206 |
Topical application of fluoride varnish |
3,835 |
2,944 |
$35K |
| D2934 |
|
2,432 |
1,732 |
$22K |
| D1510 |
|
1,645 |
1,207 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
15 |
14 |
$6K |
| D3230 |
|
183 |
122 |
$4K |
| D2335 |
|
39 |
31 |
$3K |
| D2933 |
|
48 |
41 |
$0.00 |
| D2394 |
|
19 |
13 |
$0.00 |
| D2929 |
|
12 |
12 |
$0.00 |