Dental occlusal guard

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Generation details were not recorded for this description.

Original text from hospital filings

DENTAL OCCLUSAL GUARD

Payers reporting HCPCS D9940

Payer pricing summary

Low

$228

Average

$421

Median

$366

High

$917

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Humana fee schedule · outpatient · +2 other terms	33	$1.0k	$1.2k	$246	20%	—	$152 – $1.4k
2	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	9	$304	$528	$656	124%	—	$152 – $2.6k
3	Medicaid fee schedule · outpatient	7	$466	$466	—	—	—	$466 – $466
4	Anthem facility · fee schedule · outpatient	6	$736	$731	$324	44%	—	$138 – $1.2k
5	Aetna fee schedule · outpatient · +5 other terms	5	$771	$793	$486	61%	—	$152 – $1.7k
6	Kaiser fee schedule · outpatient · +2 other terms	4	$374	$379	$117	31%	—	$152 – $523
7	Molina facility · case rate · outpatient · +1 other terms	4	$308	$325	$75	23%	—	$238 – $445
8	MultiPlan percent of total billed charges · outpatientfrom % of charges · +2 other terms	4	$373	$373	$33	9%	—	$326 – $419
9	Wellmark facility · case rate · outpatient	3	$755	$662	$209	32%	—	$308 – $833
10	UnitedHealthcare fee schedule · outpatient · +3 other terms	2	$152	$152	—	—	—	$152 – $152
11	Aetna Better Health facility · case rate · outpatient	1	$229	$229	$1	1%	—	$228 – $231
12	Amerihealth Caritas facility · case rate · outpatient	1	$238	$238	—	—	—	$238 – $238
13	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$259	$259	$29	11%	—	$230 – $288
14	Cigna facility · fee schedule · outpatient · +1 other terms	1	$488	$488	—	—	—	$488 – $488
15	Devoted professional · percent of total billed charges · inpatientfrom % of charges · +1 other terms	1	$253	$253	—	—	—	$253 – $253
16	First Health professional · fee schedule · inpatient · +4 other terms	1	$183	$183	—	—	—	$183 – $183
17	Healthpartners facility · fee schedule · outpatient	1	$488	$488	—	—	—	$488 – $488
18	Phcs percent of total billed charges · outpatientfrom % of charges	1	$419	$419	—	—	—	$419 – $419

← Hospitals reporting HCPCS D9940 · Snapshot 20261112T181611Z-3fa9fb76