| 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 |
5,775 |
4,950 |
$9.61M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20,252 |
2,696 |
$1.05M |
| D1351 |
Sealant - per tooth |
2,100 |
574 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,511 |
451 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
885 |
294 |
$40K |
| D1510 |
|
152 |
63 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,871 |
1,586 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,900 |
1,254 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
101 |
25 |
$8K |
| D2934 |
|
1,381 |
336 |
$5K |
| D1120 |
Prophylaxis - child |
448 |
404 |
$2K |
| D2933 |
|
1,132 |
219 |
$1K |
| D2330 |
|
100 |
52 |
$695.63 |
| D1206 |
Topical application of fluoride varnish |
422 |
380 |
$411.85 |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
17 |
15 |
$0.00 |
| 41899 |
Unlisted procedure, dentoalveolar structures |
454 |
354 |
$0.00 |