College of Dentistry Research Rates

D0120

PERIODIC ORAL EVALUATION - ESTABLISHED PATIENT

34.0

D0140

LIMITED ORAL EVALUATION - PROBLEM FOCUSED

44.0

D0145

ORAL EVALUATION FOR A PATIENT UNDER 3 YEARS OF AGE AND COUNSELING WITH PRIMARY CAREGIVER

80.0

D0150

COMPREHENSIVE ORAL EVAL - NEW/EST PATIENT

51.0

D0160

DETAILED AND EXTENSIVE ORAL EVALUATION - PROBLEM FOCUSED, BY REPORT

137.0

D0170

RE-EVALUATION - LIMITED, PROBLEM FOCUSED (ESTABLISHED PATIENT; NOT POST-OPERATIVE VISIT)

64.0

D0171

RE-EVALUATION - POST-OPERATIVE OFFICE VISIT

81.0

D0180

COMPREHENSIVE PERIODONTAL EVAL - NEW/EST PATIENT

51.0

D0210

INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES

118.0

D0220

INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE

10.0

D0230

INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE

10.0

D0240

INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE

23.0

D0250

EXTRAORAL - 2D PROJECTION RADIOGRAPHIC IMAGE CREATED USING A STATIONARY RADIATION SOURCE AND DETECTOR

15.0

D0251

EXTRAORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE

30.0

D0270

BITEWING - SINGLE RADIOGRAPHIC IMAGE

6.0

D0272

BITEWINGS - 2 RADIOGRAPHIC IMAGES

20.0

D0273

BITEWINGS - 3 RADIOGRAPHIC IMAGES

29.0

D0274

BITEWINGS - 4 RADIOGRAPHIC IMAGES

40.0

D0277

VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES

71.0

D0310

SIALOGRAPHY

115.0

D0320

TEMPOROMANDIBULAR JOINT ARTHROGRAM, INCLUDING INJECTION

306.0

D0321

OTHER TEMPOROMANDIBULAR JOINT RADIOGRAPHIC IMAGES, BY REPORT

92.0

D0322

TOMOGRAPHIC SURVEY

124.0

D0330

PANORAMIC RADIOGRAPHIC IMAGE

89.0

D0340

2D CEPHALOMETRIC RADIOGRAPHIC IMAGE - ACQUISITION, MEASUREMENT AND ANALYSIS

115.0

D0350

2D ORAL/FACIAL PHOTOGRAPHIC IMAGE OBTAINED INTRAORALLY OR EXTRAORALLY

24.0

D0364

CONE BEAM CT CAPTURE AND INTERPRETATION WITH LIMITED FIELD OF VIEW - LESS THAN 1 WHOLE JAW

231.0

D0365

CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF 1 FULL DENTAL ARCH - MANDIBLE

272.0

D0366

CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF 1 FULL DENTAL ARCH - MAXILLA, WITH OR WITHOUT CRANIUM

272.0

D0367

CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF BOTH JAWS; WITH OR WITHOUT CRANIUM

D0368

CONE BEAM CT CAPTURE AND INTERPRETATION FOR TMJ SERIES INCLUDING 2 OR MORE EXPOSURES

393.0

D0369

MAXILLOFACIAL MRI CAPTURE AND INTERPRETATION

210.0

D0370

MAXILLOFACIAL ULTRASOUND CAPTURE AND INTERPRETATION

60.0

D0380

CONE BEAM CT IMAGE CAPTURE WITH LIMITED FIELD OF VIEW - LESS THAN 1 WHOLE JAW

211.0

D0381

CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF 1 FULL DENTAL ARCH - MANDIBLE

242.0

D0382

CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF 1 FULL DENTAL ARCH - MAXILLA, WITH OR WITHOUT CRANIUM

242.0

D0383

CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF BOTH JAWS; WITH OR WITHOUT CRANIUM

362.0

D0384

CONE BEAM CT IMAGE CAPTURE FOR TMJ SERIES INCLUDING 2 OR MORE EXPOSURES

362.0

D0385

MAXILLOFACIAL MRI IMAGE CAPTURE

2308.0

D0386

MAXILLOFACIAL ULTRASOUND IMAGE CAPTURE

577.0

D0391

INTERPRETATION OF DIAGNOSTIC IMAGE BY A PRACTITIONER NOT ASSOCIATED WITH CAPTURE OF THE IMAGE, INCLUDING REPORT

90.0

D0393

TREATMENT SIMULATION USING 3D IMAGE VOLUME

90.0

D0411

HBA1C IN-OFFICE POINT OF SERVICE TESTING

44.0

D0414

LAB MICRBAL SPEC CULTRE/SENS/REPORT PREP TRNSMSN

89.0

D0415

COLLECTION OF MICROORGANISMS FOR CULTURE AND SENSITIVITY

80.0

D0416

VIRAL CULTURE

96.0

D0417

COLLECTION AND PREPARATION OF SALIVA SAMPLE FOR LABORATORY DIAGNOSTIC TESTING

41.0

D0418

ANALYSIS OF SALIVA SAMPLE

89.0

D0419

ASSESSMENT OF SALIVARY FLOW BY MEASUREMENT

41.0

D0422

COLLECT/PREP GENETIC SAMPLE FOR LAB ANALYSIS

65.0

D0425

CARIES SUSCEPTIBILITY TESTS

26.0

D0431

ADJUNCTIVE PREDX TST NOT INCL CYTOLOGY/BX PROC

89.0

D0460

PULP VITALITY TESTS

30.0

D0470

DIAGNOSTIC CASTS

43.0

D0472

ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT

39.0

D0473

ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT

78.0

D0474

ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, INCLUDING ASSESSMENT OF SURGICAL MARGINS FOR PRESENCE OF DISEASE, PREPARATION AND TRANSMISSION OF WRITTEN REPORT

123.0

D0475

DECALCIFICATION PROCEDURE

162.0

D0476

SPECIAL STAINS FOR MICROORGANISMS

152.0

D0477

SPECIAL STAINS NOT FOR MICROORGANISMS

208.0

D0478

IMMUNOHISTOCHEMICAL STAINS

190.0

D0479

TISSUE INSITU HYBRIDIZATION INCL INTERPRETATION

290.0

D0480

ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT

30.0

D0481

ELECTRON MICROSCOPY

670.0

D0482

DIRECT IMMUNOFLUORESCENCE

223.0

D0483

INDIRECT IMMUNOFLUORESCENCE

223.0

D0484

CONSULTATION ON SLIDES PREPARED ELSEWHERE

335.0

D0485

CONSULT INCL PREP SLIDES BX MATL SPL REF SRC

463.0

D0486

LABORATORY ACCESSION OF TRANSEPITHELIAL CYTOLOGIC SAMPLE, MICROSCOPIC EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT

102.0

D0502

OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT

14.0

D0604

ANTIGEN TEST PUB HLTH PATHOGEN INCL CORONAVIRUS

72.0

D0605

ANTIBODY TEST PUB HLTH PATHOGEN INCL CORONAVIRUS

53.0

D0701

PANORAMIC FILM - IMAGE CAPTURE ONLY

140.0

D0702

2-D CEPHALOMETRIC FILM - IMAGE CAPTURE ONLY

158.0

D0703

2-D ORAL/FACIAL FILM - IMAGE CAPTURE ONLY

75.0

D0705

EXTRA-ORAL POSTERIOR FLM - IMAGE CAPTURE ONLY

64.0

D0706

INTRAORAL OCCLUSAL FILM - IMAGE CAPTURE ONLY

57.0

D0707

INTRAORAL PERIAPICAL FLM - IMAGE CAPTURE ONLY

37.0

D0708

INTRAORAL BITEWING - IMAGE CAPTURE ONLY

36.0

D0709

INTRAORAL CMPRHNSV SERIES RAD IMAGE CAPT ONLY

183.0

D0999

UNSPECIFIED DIAGNOSTIC PROCEDURE, BY REPORT

D1110

PROPHYLAXIS - ADULT

66.0

D1120

PROPHYLAXIS - CHILD

39.0

D1206

TOPICAL APPLICATION OF FLUORIDE VARNISH

30.0

D1208

TOPICAL APPLICATION OF FLUORIDE - EXCLUDING VARNISH

30.0

D1310

NUTRITIONAL COUNSELING FOR CONTROL OF DENTAL DISEASE

25.0

D1320

TOBACCO COUNSELING FOR THE CONTROL AND PREVENTION OF ORAL DISEASE

30.0

D1321

COUNSELING FOR THE CONTROL AND PREVENTION OF ADVERSE ORAL, BEHAVIORAL, AND SYSTEMIC HEALTH EFFECTS ASSOCIATED WITH HIGH-RISK SUBSTANCE USE

48.0

D1330

ORAL HYGIENE INSTRUCTIONS

50.0

D1351

SEALANT - PER TOOTH

44.0

D1352

PREV RSN REST MOD HIGH CARIES RISK PT-PERM TOOTH

81.0

D1353

SEALANT REPAIR - PER TOOTH

D1354

INTERIM CARIES ARRESTING MEDICAMENT APPLICATION - PER TOOTH

30.0

D1355

CARIES PREVENTIVE MEDICAMENT APP - PER TOOTH

D1510D

SPACE MAINTAINER-DISTAL,FIXED,UNILATERAL,PER QUADRANT

264.0

D1510M

SPACE MAINTAINER-MESIAL,FIXED,UNILATERAL,PER QUADRANT

264.0

D1516

SPACE MAINTAINER - FIXED - BILATERAL, MAXILLARY

313.0

D1517

SPACE MAINTAINER - FIXED - BILATERAL, MANDIBULAR

313.0

D1520D

SPACE MAINTAINER-DISTAL, REMOVABLE,UNILATERAL, PER QUADRANT

264.0

D1520M

SPACE MAINTAINER-MESIAL,REMOVABLE,UNILATERAL,PER QUADRANT

264.0

D1525

REMOVE BILAT SPACE MAINTAIN

317.0

D1526

SPACE MAINTAINER - REMOVABLE - BILATERAL, MAXILLARY

317.0

D1527

SPACE MAINTAINER - REMOVABLE - BILATERAL, MANDIBULAR

317.0

D1551

RE-CEMENT OR RE-BOND BILATERAL SPACE MAINTAINER - MAXILLARY

82.0

D1552

RE-CEMENT OR RE-BOND BILATERAL SPACE MAINTAINER - MANDIBULAR

82.0

D1553

RE-CEMENT OR RE-BOND UNILATERAL SPACE MAINTAINER - PER QUADRANT

41.0

D1556

REMOVAL OF FIXED UNILATERAL SPACE MAINTAINER - PER QUADRANT

41.0

D1557

REMOVAL OF FIXED BILATERAL SPACE MAINTAINER - MAXILLARY

81.0

D1558

REMOVAL OF FIXED BILATERAL SPACE MAINTAINER - MANDIBULAR

82.0

D1575

DISTAL SHOE SPACE MAINTANR - FIXED - UNILATERIAL

439.0

D1999

UNSPECIFIED PREVENTIVE PROCEDURE, BY REPORT

D2140

AMALGAM - 1 SURFACE, PRIMARY OR PERMANENT

79.0

D2150

AMALGAM - 2 SURFACES, PRIMARY OR PERMANENT

104.0

D2160

AMALGAM - 3 SURFACES, PRIMARY OR PERMANENT

125.0

D2161

AMALGAM - 4 OR MORE SURFACES, PRIMARY OR PERMANENT

147.0

D2330

RESIN-BASED COMPOSITE - 1 SURFACE, ANTERIOR

98.0

D2331

RESIN-BASED COMPOSITE - 2 SURFACES, ANTERIOR

122.0

D2332

RESIN-BASED COMPOSITE - 3 SURFACES, ANTERIOR

147.0

D2335

RESIN-BASED COMPOSITE - 4 OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)

182.0

D2390

RESIN-BASED COMPOSITE CROWN, ANTERIOR

182.0

D2391

RESIN-BASED COMPOSITE - 1 SURFACE, POSTERIOR

98.0

D2392

RESIN-BASED COMPOSITE - 2 SURFACES, POSTERIOR

104.0

D2393

RESIN-BASED COMPOSITE - 3 SURFACES, POSTERIOR

125.0

D2394

RESIN-BASED COMPOSITE - 4 OR MORE SURFACES, POSTERIOR

147.0

D2410

GOLD FOIL - ONE SURFACE

406.0

D2420

GOLD FOIL - TWO SURFACES

676.0

D2430

GOLD FOIL - THREE SURFACES

1172.0

D2510

INLAY - METALLIC - 1 SURF

404.0

D2520

INLAY - METALLIC - 2 SURF

507.0

D2530

INLAY - METALLIC - 3+ SURF

565.0

D2542

ONLAY - METALLIC - 2 SURF

687.0

D2543

ONLAY - METALLIC - 3 SURF

725.0

D2544

ONLAY - METALLIC - 4+ SURF

725.0

D2610

INLAY - PORCELAIN/CERAMIC - 1 SURF

525.0

D2620

INLAY - PORCELAIN/CERAMIC - 2 SURF

563.0

D2630

INLAY - PORCELAIN/CERAMIC - 3+ SURF

628.0

D2642

ONLAY - PORCELAIN/CERAMIC - 2 SURF

563.0

D2643

ONLAY - PORCELAIN/CERAMIC - 3 SURF

628.0

D2644

ONLAY - PORCELAIN/CERAMIC - 4+ SURF

832.0

D2650

INLAY - RESIN-BASED COMPOSITE - 1 SURF

323.0

D2651

INLAY - RESIN-BASED COMPOSITE - 2 SURF

404.0

D2652

INLAY - RESIN-BASED COMPOSITE - 3+ SURF

466.0

D2662

ONLAY - RESIN-BASED COMPOSITE - 2 SURF

404.0

D2663

ONLAY - RESIN-BASED COMPOSITE - 3 SURF

483.0

D2664

ONLAY - RESIN-BASED COMPOSITE - 4+ SURF

563.0

D2710

CROWN - RESIN-BASED COMPOSITE (INDIRECT)

437.0

D2712

CROWN - 3/4 RESIN-BASED COMPOSITE (INDIRECT)

416.0

D2720

CROWN - RESIN WITH HIGH NOBLE METAL

832.0

D2721

CROWN - RESIN WITH PREDOMINANTLY BASE METAL

786.0

D2722

CROWN - RESIN WITH NOBLE METAL

832.0

D2740

CROWN - PORCELAIN/CERAMIC

817.0

D2750

CROWN - PFM (HIGH NOBLE METAL)

1057.0

D2751

CROWN - PFM (PREDOMINANTLY BASE METAL)

471.0

D2752

CROWN - PFM (NOBLE METAL)

471.0

D2753

CROWN - PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS

1166.0

D2780

CROWN - 3/4 CAST HIGH NOBLE METAL

1057.0

D2781

CROWN - 3/4 CAST PREDOMINANTLY BASE METAL

1057.0

D2782

CROWN - 3/4 CAST NOBLE METAL

1057.0

D2783

CROWN - 3/4 PORCELAIN/CERAMIC

1057.0

D2790

CROWN - FULL CAST HIGH NOBLE METAL

1057.0

D2791

CROWN - FULL CAST PREDOMINANTLY BASE METAL

1057.0

D2792

CROWN - FULL CAST NOBLE METAL

1057.0

D2794

DELIVERY - CROWN - FULL CAST NOBLE METAL

1118.0

D2799

DELIVERY - CROWN - TITANIUM

266.0

D2910

RE-CEMENT OR RE-BOND INLAY, ONLAY, VENEER OR PARTIAL COVERAGE RESTORATION

66.0

D2915

RE-CEMENT OR RE-BOND INDIRECTLY FABRICATED OR PREFABRICATED POST AND CORE

72.0

D2920

RE-CEMENT OR RE-BOND CROWN

50.0

D2921

REATTACHMENT OF TOOTH FRAGMENT, INCISAL EDGE OR CUSP

D2928

PREFAB PORCELAIN/CERAMIC CROWN-PERM TOOTH

507.0

D2929

PREFABRICATED PORCELAIN/CERAMIC CROWN - PRIMARY TOOTH

D2930

PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH

201.0

D2931

PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH

223.0

D2932

PREFABRICATED RESIN CROWN

142.0

D2933

PREFABRICATED STAINLESS STEEL CROWN WITH RESIN WINDOW

320.0

D2934

PREFABRICATED ESTHETIC COATED STAINLESS STEEL CROWN - PRIMARY TOOTH

369.0

D2940

PROTECTIVE RESTORATION

35.0

D2941

INTERIM THERAPEUTIC RESTORATION PRIM DENTITION

133.0

D2949

RESTOR FOUNDATION FOR INDIR RESTOR

133.0

D2950

CORE BUILDUP, INCLUDING ANY PINS WHEN REQUIRED

147.0

D2951

PIN RETENTION - PER TOOTH, IN ADDITION TO RESTORATION

32.0

D2952

POST AND CORE IN ADDITION TO CROWN, INDIRECTLY FABRICATED

261.0

D2953

EACH ADDITIONAL INDIRECTLY FABRICATED POST - SAME TOOTH

194.0

D2954

PREFAB POST AND CORE IN ADDITION TO CROWN

261.0

D2955

POST REMOVAL

209.0

D2957

EACH ADDL PREFAB POST - SAME TOOTH

155.0

D2960

LABIAL VENEER (RESIN LAMINATE) - CHAIRSIDE

315.0

D2961

LABIAL VENEER (RESIN LAMINATE) - LAB

530.0

D2962

LABIAL VENEER (PORCELAIN LAMINATE) - LAB

1057.0

D2971

Additional procedures to customize a crown to fit under and existing prtial denture framework.

D2975

COPING

453.0

D2980

CROWN REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE

192.0

D2981

INLAY REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE

113.0

D2982

ONLAY REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE

113.0

D2983

VENEER REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE

104.0

D2990

RESIN INFILT OF INCIPIENT LESIONS

88.0

D2991

APPLCATON HYDROYAPATITE REGEN MEDICMNT PER TOOTH

68.0

D2999

UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT

D3110

PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)

80.0

D3120

PULP CAP - INDIRECT (EXCLUDING FINAL RESTORATION)

77.0

D3220

THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT

122.0

D3221

PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH

177.0

D3222

PARTIAL PULPOTOMY FOR APEXOGENESIS - PERMANENT TOOTH WITH INCOMPLETE ROOT DEVELOPMENT

191.0

D3230

PULPAL THERAPY (RESORBABLE FILLING) - ANTERIOR, PRIMARY TOOTH (EXCLUDING FINAL RESTORATION)

177.0

D3240

PULPAL THERAPY (RESORBABLE FILLING) - POSTERIOR, PRIMARY TOOTH (EXCLUDING FINAL RESTORATION)

209.0

D3310

ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)

474.0

D3320

ENDODONTIC THERAPY, PREMOLAR TOOTH (EXCLUDING FINAL RESTORATION)

570.0

D3330

ENDODONTIC THERAPY, MOLAR TOOTH (EXCLUDING FINAL RESTORATION)

725.0

D3331

TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS

305.0

D3332

INCOMPLETE ENDODONTIC THERAPY; INOPERABLE, UNRESTORABLE OR FRACTURED TOOTH

417.0

D3333

INTERNAL ROOT REPAIR OF PERFORATION DEFECTS

209.0

D3346

RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - ANTERIOR

725.0

D3347

RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - PREMOLAR

872.0

D3348

RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - MOLAR

1019.0

D3351

APEXIFICATION/RECALCIFICATION - INITIAL VISIT (APICAL CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.)

115.0

D3352

APEXIFICATION/RECALCIFICATION - INTERIM MEDICATION REPLACEMENT

99.0

D3353

APEXIFICATION/RECALCIFICATION - FINAL VISIT (INCLUDES COMPLETED ROOT CANAL THERAPY - APICAL CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.)

77.0

D3355

PULPAL REGENERATION - INITIAL VISIT

111.0

D3356

PULPAL REGENERATION - INTERIM MEDICATION REPLACEMENT

99.0

D3357

PULPAL REGENERATION - COMPLETION OF TREATMENT

349.0

D3410

APICOECTOMY - ANTERIOR

196.0

D3421

APICOECTOMY - PREMOLAR (FIRST ROOT)

765.0

D3425

APICOECTOMY - MOLAR (FIRST ROOT)

867.0

D3426

APICOECTOMY (EACH ADDITIONAL ROOT)

182.0

D3428

BONE GRAFT IN CONJUNCTION WITH PERIRADICULAR SURGERY - PER TOOTH, SINGLE SITE

369.0

D3429

BONE GRAFT IN CONJUNCTION WITH PERIRADICULAR SURGERY - EACH ADDITIONAL CONTIGUOUS TOOTH IN THE SAME SURGICAL SITE

215.0

D3430

RETROGRADE FILLING - PER ROOT

121.0

D3431

BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION IN CONJUNCTION WITH PERIRADICULAR SURGERY

293.0

D3432

GUIDED TISSUE REGENERATION, RESORBABLE BARRIER, PER SITE, IN CONJUNCTION WITH PERIRADICULAR SURGERY

391.0

D3450

ROOT AMPUTATION - PER ROOT

590.0

D3460

ENDODONTIC ENDOSSEOUS IMPLANT

466.0

D3470

INTENTIONAL REIMPLANTATION (INCLUDING NECESSARY SPLINTING)

665.0

D3471

SURGICAL REPAIR OF ROOT RESORPTION - ANTERIOR

625.0

D3472

SURGICAL REPAIR OF ROOT RESORPTION - PREMOLAR

625.0

D3473

SURGICAL REPAIR OF ROOT RESORPTION - MOLAR

625.0

D3501

SURGICAL EXPOSURE OF ROOT SURFACE WITHOUT APICOECTOMY OR REPAIR OF ROOT RESORPTION - ANTERIOR

369.0

D3502

SURGICAL EXPOSURE OF ROOT SURFACE WITHOUT APICOECTOMY OR REPAIR OF ROOT RESORPTION - PREMOLAR

369.0

D3503

SURGICAL EXPOSURE OF ROOT SURFACE WITHOUT APICOECTOMY OR REPAIR OF ROOT RESORPTION - MOLAR

369.0

D3910

SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM

120.0

D3911

INTRAORIFICE BARRIER

133.0

D3920

HEMISECTION (INCLUDING ANY ROOT REMOVAL), NOT INCLUDING ROOT CANAL THERAPY

385.0

D3921

DECORONATION OR SUBMERGENCE OF AN ERUPTED TOOTH

424.0

D3950

CANAL PREPARATION AND FITTING OF PREFORMED DOWEL OR POST

140.0

D3999

UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT

D4210

GINGIVECTOMY OR GINGIVOPLASTY - 4 OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT

377.0

D4211

GINGIVECTOMY OR GINGIVOPLASTY - 1 TO 3 CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT

228.0

D4212

WAX TRY IN

179.0

D4230

ANATOMICAL CROWN EXPOSURE - 4 OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT

684.0

D4231

ANATOMICAL CROWN EXPOSURE - 1 TO 3 TEETH OR TOOTH BOUNDED SPACES PER QUADRANT

392.0

D4240

GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - 4 OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT

665.0

D4241

GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - 1 TO 3 CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT

424.0

D4245

APICALLY POSITIONED FLAP

558.0

D4249

CLINICAL CROWN LENGTHENING - HARD TISSUE

718.0

D4260

OSSEOUS SURGERY (INCLUDING ELEVATION OF A FULL THICKNESS FLAP AND CLOSURE) - 4 OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT

845.0

D4261

OSSEOUS SURGERY (INCLUDING ELEVATION OF A FULL THICKNESS FLAP AND CLOSURE) - 1 TO 3 CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT

544.0

D4263

BONE REPL GRAFT - RETAINED NATURAL TOOTH - FIRST SITE IN QUAD

424.0

D4264

BONE REPL GRAFT - RETAINED NATURAL TOOTH - EACH ADDL SITE IN QUAD

215.0

D4265

BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION

293.0

D4266

GUIDED TISSUE REGENERATION - RESORBABLE BARRIER, PER SITE

449.0

D4267

GTR - NON-RESORBABLE BARRIER, PER SITE

528.0

D4268

SURGICAL REVISION PROCEDURE, PER TOOTH

293.0

D4270

PEDICLE SOFT TISSUE GRAFT PROCEDURE

584.0

D4273

AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE (INCLUDING DONOR AND RECIPIENT SURGICAL SITES) FIRST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT

725.0

D4274

MESIAL/DISTAL WEDGE PROCEDURE, SINGLE TOOTH (WHEN NOT PERFORMED IN CONJUNCTION WITH SURGICAL PROCEDURES IN THE SAME ANATOMICAL AREA)

507.0

D4275

NON-AUTOGENOUS CONNECTIVE TISSUE GRAFT (INCL REC SITE AND DONOR MAT) FIRST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT

691.0

D4276

COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT, PER TOOTH

683.0

D4277

FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING RECIPIENT AND DONOR SURGICAL SITES) FIRST TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN GRAFT

678.0

D4278

FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING RECIPIENT AND DONOR SURGICAL SITES) EACH ADDITIONAL CONTIGUOUS TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN SAME GRAFT SITE

336.0

D4283

Autogenouse connective tissue graft procedure (including donor and recipient surgical sites)-each additional contiguous tooth, implant or edentulous tooth position in same graft site.

362.0

D4285

Non-Auto Cnnctv Tssue Grft Proc E/A Tooth/Implant

210.0

D4285

NON-AUTO CNNCTV TSSUE GRFT PROC E/A TOOTH/IMPLNT

842.0

D4286

REMOVAL OF NON-RESORBABLE BARRIER

191.0

D4322

SPLINT - INTRA-CORONAL; NATURAL TEETH OR PROSTHETIC CROWNS

397.0

D4323

SPLINT - EXTRA-CORONAL; NATURAL TEETH OR PROSTHETIC CROWNS

403.0

D4341

PERIODONTAL SCALING AND ROOT PLANING - 4 OR MORE TEETH PER QUADRANT

189.0

D4342

PERIODONTAL SCALING AND ROOT PLANING - 1 TO 3 TEETH PER QUADRANT

128.0

D4346

SCALING IN PRESENCE OF GENERALIZED MODERATE OR SEVERE GINGIVAL INFLAMMATION - FULL MOUTH, AFTER ORAL EVALUATION

143.0

D4355

FULL MOUTH DEBRIDEMENT TO ENABLE A COMPREHENSIVE ORAL EVALUATION AND DIAGNOSIS ON A SUBSEQUENT VISIT

91.0

D4381

LOCALIZED DELIVERY OF ANTIMICROBIAL AGENTS VIA A CONTROLLED RELEASE VEHICLE INTO DISEASED CREVICULAR TISSUE, PER TOOTH

77.0

D4910

PERIODONTAL MAINTENANCE

68.0

D4920

UNSCHEDULED DRESSING CHANGE (BY SOMEONE OTHER THAN TREATING DENTIST OR THEIR STAFF)

D4921

GINGIVAL IRRIGATION - PER QUADRANT

D4999

UNSPECIFIED PERIODONTAL PROCEDURE, BY REPORT

D5110

COMPLETE DENTURE - MAX

765.0

D5120

COMPLETE DENTURE - MAND

765.0

D5130

IMMEDIATE DENTURE - MAX

765.0

D5140

IMMEDIATE DENTURE - MAND

765.0

D5211

MAX PARTIAL DENTURE - RESIN BASE

392.0

D5212

MAND PARTIAL DENTURE - RESIN BASE

392.0

D5213

MAX PARTIAL DENTURE - CAST METAL FRAMEWORK W/ RESIN BASES

1033.0

D5214

MAND PARTIAL DENTURE - CAST METAL FRAMEWORK W/ RESIN BASES

1033.0

D5221

MAX PARTIAL DENTURE - RESIN BASE

D5222

MAN PARTIAL DENTURE - RESIN BASE

D5223

IMMED MAXIL PART DENTURE CAST METL FRAME W/RESIN

2250.0

D5224

IMMED MAND PART DENTURE CAST METL FRAME W/RESIN

2250.0

D5225

MAX PARTIAL DENTURE - FLEXIBLE BASE

650.0

D5226

MAND PARTIAL DENTURE - FLEXIBLE BASE

650.0

D5227

IMMEDIATE MAXILLARY PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING ANY CLASPS, RESTS AND TEETH)

1251.0

D5228

IMMEDIATE MANDIBULAR PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING ANY CLASPS, RESTS AND TEETH)

1251.0

D5282

RMVBL UNIL PRTL DNTR CST MTL INCL CLSP TTH MXLRY

1203.0

D5283

RMVBL UNIL PRTL DNTR CST MTL INCL CLSP TTH MNDBL

1203.0

D5284

RMVABLE UNI PRTL DNTURE 1 PC FLEX BASE PER QDRNT

919.0

D5286

RMVABLE UNI PRTL DNTURE 1 PC RESIN PER QDRNT

919.0

D5410

ADJUST COMPLETE DENTURE - MAXILLARY

79.0

D5411

ADJUST COMPLETE DENTURE - MANDIBULAR

79.0

D5421

ADJUST PARTIAL DENTURE - MAXILLARY

68.0

D5422

ADJUST PARTIAL DENTURE - MANDIBULAR

68.0

D5510

D5511

REPAIR BROKEN COMPLETE DENTURE BASE, MAND

134.0

D5512

REPAIR BROKEN COMPLETE DENTURE BASE, MAX

134.0

D5520

REPLACE MISSING OR BROKEN TEETH - COMPLETE DENTURE (EACH TOOTH)

134.0

D5610

D5611

REPAIR RESIN PARTIAL DENTURE BASE, MANDIBULAR

134.0

D5612

REPAIR RESIN PARTIAL DENTURE BASE, MAXILLARY

134.0

D5621

REPAIR CAST PARTIAL FRAMEWORK, MAND

288.0

D5622

REPAIR CAST PARTIAL FRAMEWORK, MAX

157.0

D5630

REPAIR/REPLACE BROKEN RETENTIVE CLASPING MATERIALS - PER TOOTH

149.0

D5640

REPLACE BROKEN TEETH - PER TOOTH

134.0

D5650

ADD TOOTH TO EXISTING PARTIAL DENTURE

78.0

D5660

ADD CLASP TO EXISTING PARTIAL DENTURE - PER TOOTH

82.0

D5670

REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MAXILLARY)

461.0

D5671

REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MANDIBULAR)

461.0

D5710

REBASE COMPLETE MAX DENTURE

323.0

D5711

REBASE COMPLETE MAND DENTURE

323.0

D5720

REBASE MAX PARTIAL DENTURE

323.0

D5721

REBASE MAND PARTIAL DENTURE

323.0

D5725

REBASE HYBRID PROSTHESIS

323.0

D5730

RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)

221.0

D5731

RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)

221.0

D5740

RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE)

192.0

D5741

RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE)

192.0

D5750

RELINE COMPLETE MAX DENTURE (LAB)

452.0

D5751

RELINE COMPLETE MAND DENTURE (LAB)

336.0

D5760

RELINE MAX PARTIAL DENTURE (LAB)

268.0

D5761

RELINE MAND PARTIAL DENTURE (LAB)

268.0

D5765

SOFT LINER FOR COMPLETE OR PARTIAL REMOVABLE DENTURE - INDIRECT

126.0

D5810

INTERIM COMPLETE DENTURE (MAX)

726.0

D5811

INTERIM COMPLETE DENTURE (MAND)

726.0

D5820

INTERIM PARTIAL DENTURE (MAX)

552.0

D5820.A

STUDENT MADE REMOVABLE TEMPORARY ACRYLIC MAX - INTERIM PARTIAL DENTURE (MAX)

341.0

D5820.B

STUDENT MADE Initial Essix Max-Interim Partial Denture (MAX)

D5820.C

STUDENT MADE Additional Essix Max - Interim Partial Denture (MAX)

D5820.D

STUDENT MADE Interim partial denture (MAX)

D5820.E

STUDENT MADE ESSIX RETAINER STUDENT MADE MAXILLARY - INTERIM PARTIAL DENTURE (MAX)

158.0

D5821

INTERIM PARTIAL DENTURE (MAND)

552.0

D5821.A

STUDENT MADE REMOVABLE TEMPORARY ACRYLIC MAND - INTERIM PARTIAL DENTURE (MAND)

393.0

D5821.B

STUDENT MADE Initial Essix Max-Interim Partial Denture (MAND)

D5821.C

STUDENT MADE Additional Essix Max - Interim Partial Denture (MAND)

D5821.D

STUDENT MADE Interim partial denture (MAND)

D5821.E

STUDENT MADE ESSIX RETAINER STUDENT MADE MANDIBULAR - INTERIM PARTIAL DENTURE (MAND)

158.0

D5850

TISSUE CONDITIONING, MAXILLARY

126.0

D5851

TISSUE CONDITIONING, MANDIBULAR

126.0

D5862

PRECISION ATTACHMENT, BY REPORT

288.0

D5863

OVERDENTURE - COMPLETE MAXILLARY

1715.0

D5864

OVERDENTURE - PARTIAL MAXILLARY

2053.0

D5865

OVERDENTURE - COMPLETE MANDIBULAR

1715.0

D5866

OVERDENTURE - PARTIAL MANDIBULAR

2053.0

D5867

REPLACEMENT OF REPLACEABLE PART OF SEMI-PRECISION OR PRECISION ATTACHMENT (MALE OR FEMALE COMPONENT)

61.0

D5875

MODIFICATION OF REMOVABLE PROSTHESIS FOLLOWING IMPLANT SURGERY

1208.0

D5899

UNSPECIFIED REMOVABLE PROSTHODONTIC PROCEDURE

D5911

FACIAL MOULAGE (SECTIONAL)

231.0

D5912

FACIAL MOULAGE (COMPLETE)

327.0

D5913

NASAL PROSTHESIS

1149.0

D5914

AURICULAR PROSTHESIS

1149.0

D5915

ORBITAL PROSTHESIS

1303.0

D5916

OCULAR PROSTHESIS

691.0

D5919

FACIAL PROSTHESIS

1155.0

D5922

NASAL SEPTAL PROSTHESIS

331.0

D5923

OCULAR PROSTHESIS, INTERIM

305.0

D5924

CRANIAL PROSTHESIS

608.0

D5925

FACIAL AUGMENTATION IMPLANT PROSTHESIS

608.0

D5926

NASAL PROSTHESIS, REPLACEMENT

548.0

D5927

AURICULAR PROSTHESIS, REPLACEMENT

548.0

D5928

ORBITAL PROSTHESIS, REPLACEMENT

670.0

D5929

FACIAL PROSTHESIS, REPLACEMENT

852.0

D5931

OBTURATOR PROSTHESIS, SURGICAL

365.0

D5932

OBTURATOR PROSTHESIS, DEFINITIVE

1314.0

D5933

OBTURATOR PROSTHESIS, MODIFICATION

92.0

D5934

MANDIBULAR RESECTION PROSTHESIS WITH GUIDE FLANGE

920.0

D5935

MANDIBULAR RESECTION PROSTHESIS WITHOUT GUIDE FLANGE

5326.0

D5936

OBTURATOR PROSTHESIS, INTERIM

657.0

D5937

TRISMUS APPLIANCE (NOT FOR TMD TREATMENT)

537.0

D5951

FEEDING AID

231.0

D5952

SPEECH AID PROSTHESIS, PEDIATRIC

383.0

D5953

SPEECH AID PROSTHESIS, ADULT

767.0

D5954

PALATAL AUGMENTATION PROSTHESIS

691.0

D5955

PALATAL LIFT PROSTHESIS, DEFINITIVE

584.0

D5958

PALATAL LIFT PROSTHESIS, INTERIM

406.0

D5959

PALATAL LIFT PROSTHESIS, MODIFICATION

92.0

D5960

SPEECH AID PROSTHESIS, MODIFICATION

92.0

D5982

SURGICAL STENT

293.0

D5983

RADIATION CARRIER

730.0

D5984

RADIATION SHIELD

584.0

D5985

RADIATION CONE LOCATOR

730.0

D5986

FLUORIDE GEL CARRIER

82.0

D5987

COMMISSURE SPLINT

308.0

D5988

SURGICAL SPLINT

308.0

D5991

VESICULOBULLOUS DISEASE MEDICAMENT CARRIER

131.0

D5993

MAINTENANCE AND CLEANING OF A MAXILLOFACIAL PROSTHESIS (EXTRAORAL OR INTRAORAL) OTHER THAN REQUIRED ADJUSTMENTS, BY REPORT

D5995

PERIO MEDIC CARRIER PERIPH SEAL LAB PRCESSD MAX

938.0

D5996

PERIO MEDIC CARRIER PERIPH SEAL LAB PRCESSD MAN

938.0

D5999

UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT

D6010

SURGICAL PLACEMENT OF IMPLANT BODY - ENDOSTEAL IMPLANT

1546.0

D6011

SECOND STAGE IMPLANT SURGERY

D6012

SURG PLACEMENT OF INTERIM IMPL BODY FOR TRANS PROSTHESIS - ENDOSTEAL IMPL

1971.0

D6013

SURGICAL PLACEMENT OF MINI IMPLANT

D6040

SURGICAL PLACEMENT - EPOSTEAL IMPLANT

1021.0

D6050

SURGICAL PLACEMENT - TRANSOSTEAL IMPLANT

1021.0

D6051

INTERIM ABUTMENT

480.0

D6055

CONNECTING BAR - IMPL/ABUT SUPPORTED

D6056

PREFAB ABUTMENT - INCLUDES MODIFICATION AND PLACEMENT

608.0

D6057

CUSTOM FABRICATED ABUTMENT - INCLUDES PLACEMENT

789.0

D6058

ABUT SUPPORTED PORCELAIN/CERAMIC CROWN

1158.0

D6059

ABUT SUPPORTED PFM CROWN (HIGH NOBLE METAL)

1225.0

D6060

ABUT SUPPORTED PFM CROWN (PREDOMINANTLY BASE METAL)

1225.0

D6061

ABUT SUPPORTED PFM CROWN (NOBLE METAL)

1225.0

D6062

ABUT SUPPORTED CAST METAL CROWN (HIGH NOBLE METAL)

1225.0

D6063

ABUT SUPPORTED CAST METAL CROWN (PREDOMINANTLY BASE METAL)

1225.0

D6064

ABUT SUPPORTED CAST METAL CROWN (NOBLE METAL)

1225.0

D6065

IMPL SUPPORTED PORCELAIN/CERAMIC CROWN

1225.0

D6066

IMPL SUPPORTED CROWN - PFM (HIGH NOBLE ALLOYS)

1225.0

D6067

IMPL SUPPORTED CROWN - HIGH NOBLE ALLOYS

1430.0

D6068

ABUT SUPPORTED RETAINER FOR PORCELAIN/CERAMIC FPD

1331.0

D6069

ABUT SUPPORTED RETAINER FOR PFM FPD (HIGH NOBLE METAL)

1331.0

D6070

ABUT SUPPORTED RETAINER FOR PFM FPD (PREDOMINANTLY BASE METAL)

1119.0

D6071

ABUT SUPPORTED RETAINER FOR PFM FPD (NOBLE METAL)

1287.0

D6072

ABUT SUPPORTED RETAINER FOR CAST METAL FPD (HIGH NOBLE METAL)

1156.0

D6073

ABUT SUPPORTED RETAINER FOR CAST METAL FPD (PREDOMINANTLY BASE METAL)

1056.0

D6074

ABUT SUPPORTED RETAINER FOR CAST METAL FPD (NOBLE METAL)

1290.0

D6075

IMPL SUPPORTED RETAINER FOR CERAMIC FPD

13314.0

D6076

IMPL SUPPORTED RETAINER FOR FPD - PFM (HIGH NOBLE ALLOYS)

1323.0

D6077

IMPL SUPPORTED RETAINER FOR METAL FPD - HIGH NOBLE ALLOYS

1116.0

D6078

D6079

D6080

IMPLANT MAINTENANCE PROCEDURES WHEN PROSTHESES ARE REMOVED AND REINSERTED, INCLUDING CLEANSING OF PROSTHESES AND ABUTMENTS

121.0

D6081

Scaling/Dbrdmnt Implnt WO Flap Entry/Clos

75.0

D6081

SCALNG/DBRDMNT IMPLNT WO FLAP ENTRY/CLOS

75.0

D6082

IMPLANT SUPPORTED CROWN - Porcelain fused to predominantly base alloys

1722.0

D6083

IMPL SUPPORTED CROWN - PFM (NOBLE ALLOYS)

1225.0

D6084

IMPL SUPP CROWN PORCLN FUSED TO TITANIUM ALLOYS

1722.0

D6085

PROVISIONAL IMPLANT CROWN

194.0

D6086

IMPLANT SUPPORTED CROWN PREDOM BASE ALLOYS

1671.0

D6087

IMPLANT SUPPORTED CROWN NOBLE ALLOYS

1671.0

D6088

IMPLNT SUPRTD CROWN TITANIUM AND ALLOYS

1671.0

D6090

REPAIR IMPLANT SUPPORTED PROSTHESIS, BY REPORT

320.0

D6091

REPLACEMENT OF SEMI-PRECISION OR PRECISION ATTACHMENT (MALE OR FEMALE COMPONENT) OF IMPLANT/ABUTMENT SUPPORTED PROSTHESIS, PER ATTACHMENT

61.0

D6092

RE-CEMENT OR RE-BOND IMPLANT/ABUTMENT SUPPORTED CROWN

106.0

D6093

RE-CEMENT OR RE-BOND IMPLANT/ABUTMENT SUPPORTED FIXED PARTIAL DENTURE

145.0

D6094

ABUTMENT SUPPORTED CROWN - TITANIUM AND TITANIUM ALLOYS

1066.0

D6096

REMOVE BROKEN IMPLANT RETAINING SCREW

529.0

D6097

ABUT SUPP CROWN - PORC FUSED TO TITAN AND TITAN ALLOYS

1173.0

D6098

IMPL SUPP RETAINER PORCELAIN FUSED TO BASE ALLOY

1676.0

D6099

IMPL SUPP RETAINR FPD PORCLN FUSED NOBLE ALLOYS

1710.0

D6100

IMPLANT REMOVAL

331.0

D6101

DEBRIDEMENT OF A PERI-IMPLANT DEFECT OR DEFECTS SURROUNDING A SINGLE IMPLANT, AND SURFACE CLEANING OF THE EXPOSED IMPLANT SURFACES, INCLUDING FLAP ENTRY AND CLOSURE

439.0

D6102

DEBRIDEMENT AND OSSEOUS CONT OF A PERI-IMPLANT DEFECTS SURR A SINGLE IMPLANT AND INCL SURFACE CLEANING OF THE EXPOSED IMPLANT SURFACES, INCL FLAP ENTRY AND CLOSURE

499.0

D6103

BONE GRAFT FOR REPAIR OF PERI-IMPLANT DEFECT - DOES NOT INCLUDE FLAP ENTRY AND CLOSURE

379.0

D6104

BONE GRAFT AT TIME OF IMPLANT PLACEMENT

379.0

D6105

RMVL IMPLANT NO BONE REMOVAL OR FLAP ELEVATION

186.0

D6106

GIDED TISS REGENRATION RESORB BARRIER PER IMPLNT

597.0

D6107

GIDED TISS REGENRATION NONRESORB BARRIER PER IMP

767.0

D6110

IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR EDENTULOUS ARCH - MAXILLARY

2020.0

D6111

IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR EDENTULOUS ARCH - MANDIBULAR

2020.0

D6112

IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH - MAXILLARY

2020.0

D6113

IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH - MANDIBULAR

2020.0

D6114

IMPL/ABUT SUPPORTED FIXED DENTURE FOR EDENT ARCH - MAX

6563.0

D6114A

IMPLANT A S MAXILLARY FULL ARCH PROSTHESES, ZIRCONIA BASED

10017.0

D6114B

IMPLANT A S MAXILLARY FULL ARCH PROSTHESES, TI FRAME

13125.0

D6114C

IMPLANT A S MAXILLARY FULL ARCH PROSTHESES, CRCO FRAME

13125.0

D6114D

IMPLANT A S MAXILLARY FULL ARCH PROSTHESES, DIGITAL DENTURE

7350.0

D6115

IMPLANT/ABUTMENT SUPPORTED FD - MANDIBULAR FULL

6563.0

D6115A

IMPLANT A S - MAND FULL ARCH PROSTHESIS, ZIRCONIA BASED

10017.0

D6115B

IMPLANT A S - MAND FULL ARCH PROSTHESIS, TI FRAME

13125.0

D6115C

IMPLANT A S - MAND FULL ARCH PROSTHESIS, CRCO FRAME

13125.0

D6115D

IMPLANT A S - MAND FULL ARCH PROSTHESIS, DIGITAL DENTURE

7350.0

D6116

IMPL/ABUT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENT ARCH - MAX

3646.0

D6117

IMPL/ABUT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENT ARCH - MAND

3646.0

D6118

IMPLANT/ABUTMENT SUPPORTED INTERIM FIXED DENTURE FOR EDENTULOUS ARCH - MANDIBULAR

631.0

D6119

IMPLANT/ABUTMENT SUPPORTED INTERIM FIXED DENTURE FOR EDENTULOUS ARCH - MAXILLARY

631.0

D6120

IMPLANT SUPPORTED RETAINER-PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS

1676.0

D6121

IMPLANT SUPPORTED METAL RPD RETAINER

1580.0

D6122

IMPLANT SUPPORTED RETAINER FOR METAL FPD-NOBLE ALLOYS

1679.0

D6123

IMPLANT SUPPORTED RETAINER FOR METAL FPD-TITANIUM AND TITANIUM ALLOYS

1580.0

D6180

IMPLANT MAINTENANCE PROCEDURES WHEN A FULL ARCH FIXED HYBRID PROSTHESIS IS NOT REMOVED.

D6190

RADIOGRAPHIC/SURGICAL IMPLANT INDEX

273.0

D6190.A

COMPUTER GENERATED SURGICAL GUIDE - RADIOGRAPHIC/SURGICAL IMPLANT INDEX

473.0

D6191

SEMI-PRECISION ABUTMENT - PLACEMENT

53.0

D6192

SEMI-PRECISION ATTACHMENT - PLACEMENT

53.0

D6193

REPLACEMENT OF AN IMPLANT SCREW

61.0

D6194

ABUTMENT SUPPORTED RETAINER CROWN FOR FPD - TITANIUM AND TITANIUM ALLOYS

968.0

D6195

ABUT SUPP RETAINR PORCLN FUSED TITANIUM ALLOYS

1706.0

D6197

REPLACEMENT OF RESTORATIVE MATERIAL USED TO CLOSE AN ACCESS OPENING OF A SCREW-RETAINED IMPLANT SUPPORTED PROSTHESIS, PER IMPLANT

53.0

D6198

REMOVE INTERIM IMPLANT COMPONENT

315.0

D6199

UNSPECIFIED IMPLANT PROCEDURE, BY REPORT

D6199A

REPLACE PORCELAIN ON A CROWN

242.0

D6205

PONTIC - INDIRECT RESIN BASED COMPOSITE

654.0

D6210

PONTIC - CAST HIGH NOBLE METAL

920.0

D6211

PONTIC - CAST PREDOMINANTLY BASE METAL

920.0

D6212

PONTIC - CAST NOBLE METAL

920.0

D6214

PONTIC - TITANIUM

1006.0

D6240

PONTIC - PFM (HIGH NOBLE METAL)

1057.0

D6241

PONTIC - PFM (PREDOMINANTLY BASE METAL)

1057.0

D6242

PONTIC - PFM (NOBLE METAL)

1057.0

D6243

PONTIC - PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS

1006.0

D6245

PONTIC - PORCELAIN/CERAMIC

1057.0

D6250

PONTIC - RESIN WITH HIGH NOBLE METAL

1057.0

D6251

PONTIC - RESIN WITH PREDOMINANTLY BASE METAL

1057.0

D6252

PONTIC - RESIN WITH NOBLE METAL

1057.0

D6253

PROVISIONAL PONTIC - FURTHER TREATMENT OR COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO FINAL IMPRESSION

42.0

D6545

RETAINER - CAST METAL FOR RESIN BONDED FIXED PROSTHESIS

464.0

D6548

RETAINER - PORCELAIN/CERAMIC FOR RESIN BONDED FIXED PROSTHESIS

471.0

D6549

RESIN RETAINER FOR RESIN BONDED FIXED PROSTHESIS

368.0

D6600

RETAINER INLAY - PORCELAIN/CERAMIC, 2 SURF

760.0

D6601

RETAINER INLAY - PORCELAIN/CERAMIC, 3+ SURF

798.0

D6602

DELIVERY - RETAINER INLAY - PORCELAIN/CERAMIC, 3+ SURF

814.0

D6603

DELIVERY - RETAINER INLAY - CAST HIGH NOBLE METAL, 2 SURF

920.0

D6604

RETAINER INLAY - CAST PREDOMINANTLY BASE METAL, 2 SURF

797.0

D6605

RETAINER INLAY - CAST PREDOMINANTLY BASE METAL, 3+ SURF

920.0

D6606

RETAINER INLAY - CAST NOBLE METAL, 2 SURF

784.0

D6607

RETAINER INLAY - CAST NOBLE METAL, 3+ SURF

920.0

D6608

RETAINER ONLAY - PORCELAIN/CERAMIC, 2 SURF

920.0

D6609

RETAINER ONLAY - PORCELAIN/CERAMIC, 3+ SURF

920.0

D6610

RETAINER ONLAY - CAST HIGH NOBLE METAL, 2 SURF

920.0

D6611

RETAINER ONLAY - CAST HIGH NOBLE METAL, 3+ SURF

920.0

D6612

RETAINER ONLAY - CAST PREDOMINANTLY BASE METAL, 2 SURF

920.0

D6613

RETAINER ONLAY - CAST PREDOMINANTLY BASE METAL, 3+ SURF

920.0

D6614

RETAINER ONLAY - CAST NOBLE METAL, 2 SURF

920.0

D6615

RETAINER ONLAY - CAST NOBLE METAL, 3+ SURF

920.0

D6624

RETAINER INLAY - TITANIUM

791.0

D6634

RETAINER ONLAY - TITANIUM

830.0

D6710

RETAINER CROWN - INDIRECT RESIN BASED COMPOSITE

1057.0

D6720

RETAINER CROWN - RESIN WITH HIGH NOBLE METAL

D6721

RETAINER CROWN - RESIN WITH PREDOMINANTLY BASE METAL

1057.0

D6722

RETAINER CROWN - RESIN WITH NOBLE METAL

1057.0

D6740

RETAINER CROWN - PORCELAIN/CERAMIC

1057.0

D6750

RETAINER CROWN - PFM (HIGH NOBLE METAL)

1057.0

D6751

RETAINER CROWN - PFM (PREDOMINANTLY BASE METAL)

1057.0

D6752

RETAINER CROWN - PFM (NOBLE METAL)

1057.0

D6753

RETAINER CROWN - PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS

1104.0

D6780

RETAINER CROWN - 3/4 CAST HIGH NOBLE METAL

1057.0

D6781

RETAINER CROWN - 3/4 CAST PREDOMINANTLY BASE METAL

1057.0

D6782

RETAINER CROWN - 3/4 CAST NOBLE METAL

1057.0

D6783

RETAINER CROWN - 3/4 PORCELAIN/CERAMIC

1057.0

D6784

RETAINER CROWN 3/4 - TITANIUM AND TITANIUM ALLOYS

1057.0

D6790

RETAINER CROWN - FULL CAST HIGH NOBLE METAL

1057.0

D6791

RETAINER CROWN - FULL CAST PREDOMINANTLY BASE METAL

1057.0

D6792

RETAINER CROWN - FULL CAST NOBLE METAL

1057.0

D6793

PROVISIONAL RETAINER CROWN - FURTHER TREATMENT OR COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO FINAL IMPRESSION

461.0

D6794

RETAINER CROWN - TITANIUM

1104.0

D6920

CONNECTOR BAR

3150.0

D6930

RE-CEMENT OR RE-BOND FIXED PARTIAL DENTURE

85.0

D6940

STRESS BREAKER

211.0

D6950

PRECISION ATTACHMENT

314.0

D6980

FIXED PARTIAL DENTURE REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE

256.0

D6985

PEDIATRIC PARTIAL DENTURE, FIXED

504.0

D6999

UNSPECIFIED FIXED PROSTHODONTIC PROCEDURE, BY REPORT

D7111

EXTRACTION, CORONAL REMNANTS - PRIMARY TOOTH

107.0

D7140

EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL)

114.0

D7210

EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED

114.0

D7220

REMOVAL OF IMPACTED TOOTH - SOFT TISSUE

195.0

D7230

REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY

298.0

D7240

REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY

371.0

D7241

REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY, WITH UNUSUAL SURGICAL COMPLICATIONS

383.0

D7250

REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)

127.0

D7251

CORONECTOMY - INTENTIONAL PARTIAL TOOTH REMOVAL

382.0

D7260

OROANTRAL FISTULA CLOSURE

270.0

D7261

PRIMARY CLOSURE OF A SINUS PERFORATION

672.0

D7270

TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED TOOTH

194.0

D7272

TOOTH TRANSPLANTATION (INCLUDES REIMPLANTATION FROM ONE SITE TO ANOTHER AND SPLINTING AND/OR STABILIZATION)

383.0

D7280

EXPOSURE OF AN UNERUPTED TOOTH

292.0

D7282

MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION

231.0

D7283

PLACEMENT OF DEVICE TO FACILITATE ERUPTION OF IMPACTED TOOTH

83.0

D7284

EXCISIONAL BIOPSY OF MINOR SALIVARY GLANDS

1332.0

D7285

INCISIONAL BIOPSY OF ORAL TISSUE-HARD (BONE, TOOTH)

165.0

D7286

INCISIONAL BIOPSY OF ORAL TISSUE-SOFT

143.0

D7287

EXFOLIATIVE CYTOLOGICAL SAMPLE COLLECTION

16.0

D7288

BRUSH BIOPSY - TRANSEPITHELIAL SAMPLE COLLECTION

266.0

D7290

SURGICAL REPOSITIONING OF TEETH

233.0

D7291

TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, BY REPORT

177.0

D7292

PLACEMENT OF TEMPORARY ANCHORAGE DEVICE (SCREW RETAINED PLATE) REQUIRING FLAP; INCLUDES DEVICE REMOVAL

1115.0

D7293

SURG PLCMT: TEMP ANCHORAGE DEVICE RQR SURG FLAP

666.0

D7294

SURG PLCMT: TEMP ANCHORAGE DEVICE W/O SURG FLAP

555.0

D7296

CORTICOTOMY - 1 TO 3 TEETH OR TOOTH SPACES, PER QUADRANT

478.0

D7297

CORTICOTOMY - 4 OR MORE TEETH OR TOOTH SPACES, PER QUADRANT

597.0

D7310

ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - 4 OR MORE TEETH OR TOOTH SPACES, PER QUADRANT

194.0

D7311

ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - 1 TO 3 TEETH OR TOOTH SPACES, PER QUADRANT

95.0

D7320

ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - 4 OR MORE TEETH OR TOOTH SPACES, PER QUADRANT

231.0

D7321

ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - 1 TO 3 TEETH OR TOOTH SPACES, PER QUADRANT

440.0

D7340

VESTIBULOPLASTY - RIDGE EXTENSION (SECONDARY EPITHELIALIZATION)

308.0

D7350

VESTIBULOPLASTY - RIDGE EXTENSION (INCLUDING SOFT TISSUE GRAFTS, MUSCLE REATTACHMENT, REVISION OF SOFT TISSUE ATTACHMENT AND MANAGEMENT OF HYPERTROPHIED AND HYPERPLASTIC TISSUE)

383.0

D7410

EXCISION OF BENIGN LESION UP TO 1.25 CM

293.0

D7411

EXCISION OF BENIGN LESION GREATER THAN 1.25 CM

438.0

D7412

EXCISION OF BENIGN LESION, COMPLICATED

730.0

D7413

EXCISION OF MALIGNANT LESION UP TO 1.25 CM

293.0

D7414

EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM

438.0

D7415

EXCISION OF MALIGNANT LESION, COMPLICATED

730.0

D7440

EXC MALIG TUMOR-LESION DIAMETER UP TO 1.25 CM

1881.0

D7441

EXC MALIG TUMOR-LESION DIAM GREATER THAN 1.25 CM

2772.0

D7450

REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM

203.0

D7451

REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN 1.25 CM

441.0

D7460

REMOVAL OF BENIGN NON-ODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM

415.0

D7461

REMOVAL OF BENIGN NON-ODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN 1.25 CM

345.0

D7465

DESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL METHOD, BY REPORT

224.0

D7471

REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE)

243.0

D7472

REMOVAL OF TORUS PALATINUS

243.0

D7473

REMOVAL OF TORUS MANDIBULARIS

243.0

D7485

REDUCTION OF OSSEOUS TUBEROSITY

487.0

D7490

RADICAL RESECTION OF MAXILLA OR MANDIBLE

11880.0

D7509

MARSUPIALIZATION OF ODONTOGENIC CYST

D7510

INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE

146.0

D7511

I & D ABSCESS INTRAORAL SOFT TISSUE COMPLICATED

644.0

D7520

INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE

537.0

D7521

I & D ABSCESS EXTRAORAL SOFT TISSUE COMPLICATED

2228.0

D7530

REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE

518.0

D7540

REMOVAL OF REACTION PRODUCING FOREIGN BODIES, MUSCULOSKELETAL SYSTEM

630.0

D7550

PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE

269.0

D7560

MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT OR FOREIGN BODY

383.0

D7610

MAXILLA - OPEN REDUCTION (TEETH IMMOBILIZED, IF PRESENT)

3063.0

D7620

MAXILLA - CLOSED REDUCTION (TEETH IMMOBILIZED, IF PRESENT)

2297.0

D7630

MANDIBLE - OPEN REDUCTION (TEETH IMMOBILIZED, IF PRESENT)

3063.0

D7640

MANDIBLE - CLOSED REDUCTION (TEETH IMMOBILIZED, IF PRESENT)

1838.0

D7650

MALAR AND/OR ZYGOMATIC ARCH - OPEN REDUCTION

4053.0

D7660

MALAR AND/OR ZYGOMATIC ARCH - CLOSED REDUCTION

2390.0

D7670

ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH

383.0

D7671

ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH

401.0

D7680

FACE BONES-COMP RDUC W/FIX&MX SURG APPRCHES CPT

12159.0

D7710

MAXILLA - OPEN REDUCTION

7621.0

D7720

MAXILLA - CLOSED REDUCTION

5350.0

D7730

MANDIBLE - OPEN REDUCTION

11025.0

D7740

MANDIBLE - CLOSED REDUCTION

5455.0

D7750

MALAR AND/OR ZYGOMATIC ARCH - OPEN REDUCTION

6938.0

D7760

MALAR AND/OR ZYGOMATIC ARCH - CLOSED REDUCTION

2784.0

D7770

ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH

462.0

D7771

ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH

438.0

D7780

FACIAL BONES-COMP RDUC FIX & MULT APPROACHES

16212.0

D7810

OPEN REDUCTION OF DISLOCATION

7132.0

D7820

CLOSED REDUCTION OF DISLOCATION

169.0

D7830

MANIPULATION UNDER ANESTHESIA

169.0

D7840

CONDYLECTOMY

9722.0

D7850

SURGICAL DISCECTOMY WITH/WITHOUT IMPLANT

8395.0

D7852

DISC REPAIR

9613.0

D7854

SYNOVECTOMY

9920.0

D7856

MYOTOMY

7039.0

D7858

JOINT RECONSTRUCTION

20063.0

D7860

ARTHROTOMY

8552.0

D7865

ARTHROPLASTY

13781.0

D7870

ARTHROCENTESIS

193.0

D7871

NON-ARTHROSCOPIC LYSIS AND LAVAGE

911.0

D7872

ARTHROSCOPY - DIAGNOSIS WITH OR WITHOUT BIOPSY

4861.0

D7873

ARTHROSCOPY: LAVAGE & LYSIS ADHESIONS

5853.0

D7874

ARTHROSCOPY: DISC REPSTN & STABILIZATION

8395.0

D7875

ARTHROSCOPY: SYNOVECTOMY

9197.0

D7876

ARTHROSCOPY: DISCECTOMY

9916.0

D7877

ARTHROSCOPY: DEBRIDEMENT

8752.0

D7880

OCCLUSAL ORTHOTIC DEVICE, BY REPORT

453.0

D7881

OCCLUSAL ORTHOTIC DEVICE ADJUSTMENT

119.0

D7899

UNSPECIFIED TMD THERAPY, BY REPORT

D7910

SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM

140.0

D7911

COMPLICATED SUTURE - UP TO 5 CM

154.0

D7912

COMPLICATED SUTURE - GREATER THAN 5 CM

461.0

D7920

SKIN GRAFT (IDENTIFY DEFECT COVERED, LOCATION AND TYPE OF GRAFT)

315.0

D7921

COLL APPL AUTOLOGOUS BLD CNCNTRT PRODUCT

442.0

D7922

PLACEMENT INTRA-SOCKET BIOLOGICAL DRESSING TO AID IN HEMOSTASIS PER SITE

11.0

D7922

PLACEMENT OF COLLAPLUG TO AID IN HEMOSTASIS

11.0

D7922

PLACEMENT OF GEL FOAM TO AID IN HEMOSTASIS

11.0

D7922

PLACEMENT OF SURGICEL TO AID IN HEMOSTASIS

11.0

D7922

PLACEMENT OF GEL FOAM W/ THROMBIN TO AID IN HEMOSTASIS

11.0

D7941

OSTEOTOMY - MANDIBULAR RAMI

12177.0

D7943

OSTEOT-MANDIB RAMI W/BONE GRFT;INCL OBTAIN GRAFT

11187.0

D7944

2625.0

D7945

OSTEOTOMY - BODY OF MANDIBLE

13266.0

D7946

LEFORT I (MAXILLA - TOTAL)

16434.0

D7947

LEFORT I (MAXILLA - SEGMENTED)

13820.0

D7948

LEFORT II/LEFORT III - W/O BONE GRAFT

17939.0

D7949

LEFORT II OR LEFORT III - WITH BONE GRAFT

23364.0

D7950

OSS/OSTEOPERIOSTEAL/CARTILAGE GRAFT OF THE MANDIBLE OR MAXILLA

1378.0

D7951

SINUS AUGMENTATION WITH BONE VIA LATERAL OPEN APPROACH

433.0

D7951

SINUS AUGUMENTATION WITH BONE VIA LATERAL OPEN APPROACH

D7953

BONE REPLACEMENT GRAFT FOR RIDGE PRESERVATION - PER SITE

356.0

D7955

REPAIR OF MAXILLOFACIAL SOFT AND/OR HARD TISSUE DEFECT

D7956

GIDED TISS REGENRATION EDENT RESORB BARR PR SITE

693.0

D7957

GIDED TISS REGENRATION EDENT NONRESORB BARR SITE

891.0

D7961

BUCCAL/LABIAL FRENECTOMY (FRENULECTOMY)

132.0

D7962

LINGUAL FRENECTOMY (FRENULECTOMY)

132.0

D7963

FRENULOPLASTY

891.0

D7970

EXCISION OF HYPERPLASTIC TISSUE - PER ARCH

73.0

D7971

EXCISION OF PERICORONAL GINGIVA

292.0

D7972

SURGICAL REDUCTION OF FIBROUS TUBEROSITY

278.0

D7979

NON-SURGICAL SIALOLITHOTOMY

288.0

D7980

SURGICAL SIALOLITHOTOMY

383.0

D7981

EXCISION OF SALIVARY GLAND, BY REPORT

D7982

SIALODOCHOPLASTY

421.0

D7983

CLOSURE OF SALIVARY FISTULA

2831.0

D7990

EMERGENCY TRACHEOTOMY

2188.0

D7991

CORONOIDECTOMY

5940.0

D7995

SYNTHETIC GRAFT - MANDIBLE OR FACIAL BONES, BY REPORT

1103.0

D7995.A

SMALL PUROS BLOCK GRAFT MATERIAL

D7995.B

MEDIUM PUROS BLOCK GRAFT MATERIAL

D7996

IMPLANT-MANDIBLE FOR AUGMENTATION PURPOSES (EXCLUDING ALVEOLAR RIDGE), BY REPORT

1103.0

D7997

APPLIANCE REMOVAL (NOT BY DENTIST WHO PLACED APPLIANCE), INCLUDES REMOVAL OF ARCHBAR

278.0

D7998

INTRAORAL PLCMT FIX DEVICE NOT CONJUNCTION W/FX

1980.0

D7999

UNSPECIFIED ORAL SURGERY PROCEDURE, BY REPORT

D8030

LIMITED ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION

2371.0

D8040

LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION

2371.0

D8040.A

LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION, 3 MONTHS, BRACES

D8040.B

LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION, 6 MONTHS, BRACES

D8040.C

LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION, 9 MONTHS, BRACES

D8040.D

LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION, 12 MONTHS, BRACES

D8040.E

LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION, 3 MONTHS, CLEAR ALIGNERS

2704.0

D8040.F

LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION, 6 MONTHS, CLEAR ALIGNERS

2704.0

D8040.G

LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION, 9 MONTHS, CLEAR ALIGNERS

2704.0

D8040.H

LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION, 12 MONTHS, CLEAR ALIGNERS

2704.0

D8070

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION

1506.0

D8080

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION

1193.0

D8080.D

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION 12 MONTHS, BRACES

D8080.E

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION 15 MONTHS, BRACES

D8080.F

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION 18 MONTHS, BRACES

D8080.G

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION 21 MONTHS, BRACES

D8080.H

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION 24 MONTHS, BRACES

D8080.L

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION 12 MONTHS, CLEAR ALIGNERS

D8080.M

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION 15 MONTHS, CLEAR ALIGNERS

D8080.N

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION 18 MONTHS, CLEAR ALIGNERS

D8080.O

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION 21 MONTHS, CLEAR ALIGNERS

D8080.P

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION 24 MONTHS, CLEAR ALIGNERS

D8090

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION

4172.0

D8090.D

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION 12 MONTHS, BRACES

D8090.E

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION 15 MONTHS, BRACES

D8090.F

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION 18 MONTHS, BRACES

D8090.G

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION 21 MONTHS, BRACES

D8090.H

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION 24 MONTHS, BRACES

D8090.L

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION 12 MONTHS, CLEAR ALIGNERS

D8090.M

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION 15 MONTHS, CLEAR ALIGNERS

D8090.N

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION 18 MONTHS, CLEAR ALIGNERS

D8090.O

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION 21 MONTHS, CLEAR ALIGNERS

D8090.P

COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION 24 MONTHS, CLEAR ALIGNERS

D8210

REMOVABLE APPLIANCE THERAPY

392.0

D8220

FIXED APPLIANCE THERAPY

574.0

D8660

PRE-ORTHODONTIC TREATMENT EXAMINATION TO MONITOR GROWTH AND DEVELOPMENT

D8670

PERIODIC ORTHODONTIC TREATMENT VISIT

D8680

ORTHODONTIC RETENTION (REMOVAL OF APPLIANCES, CONSTRUCTION AND PLACEMENT OF RETAINER(S))

D8695

REMOVAL OF FIXED ORTHODONTIC APPLIANCES FOR REASONS OTHER THAN COMPLETION OF TREATMENT

400.0

D8696

REPAIR OF ORTHODONTIC APPLIANCE - MAXILLARY

82.0

D8697

REPAIR OF ORTHODONTIC APPLIANCE - MANDIBULAR

82.0

D8698

RE-CEMENT OR RE-B0ND FIXED RETAINER MAXILLARY

61.0

D8699

RE-CEMENT OR RE-BOND FIXED RETAINER MANDIBULAR

61.0

D8701

REPAIR OF FIXED RETAINER, INCLUDES REATTACHMENT - MAXILLARY

29.0

D8702

REPAIR OF FIXED RETAINER, INCLUDES REATTACHMENT - MANDIBULAR

29.0

D8703

REPLACEMENT OF LOST OR BROKEN RETAINER - MAXILLARY

164.0

D8703.A

REPLACEMENT OF LOST OR BROKEN RETAINER (ESSIX) - MAXILLARY

82.0

D8703.B

REPLACEMENT OF LOST OR BROKEN RETAINER (LBR) - MAXILLARY

59.0

D8703.C

VIVERA SINGLE ARCH-INVISALIGN PERM RETAINER - MAXILLARY

201.0

D8703.D

ACCUTECH RETAINER - MAXILLARY

302.0

D8703.E

INITIAL REPLACEMENT TRAY FOR INVISALIGN - MAXILLARY

55.0

D8703.F

CLEAR BOW RETAINER - MAXILLARY

222.0

D8704

REPLACE LOST OR BROKEN RETAINER MANDIBULAR

164.0

D8704.A

REPLACEMENT OF LOST OR BROKEN RETAINER (ESSIX) - MANDIBULAR

82.0

D8704.B

REPLACEMENT OF LOST OR BROKEN RETAINER (LBR) - MANDIBULAR

59.0

D8704.C

VIVERA SINGLE ARCH-INVISALIGN PERM RETAINER - MANDIBULAR

201.0

D8704.D

ACCUTECH RETAINER - MANDIBULAR

302.0

D8704.E

INITIAL REPLACEMENT TRAY FOR INVISALIGN - MANDIBULAR

55.0

D8704.F

CLEAR BOW RETAINER - MANDIBULAR

222.0

D8999

UNSPECIFIED ORTHODONTIC PROCEDURE, BY REPORT

D8999.A

ORAL B PROF ORTHO TOOTHBRUSH KIT

69.88

D8999.B

ORAL B ORTHO REPLACEMENT HEAD

8.6

D8999.C

CERAMIC BRACKETS W/COATED WIRES

363.0

D8999.D

UPPER CERAMIC BRACKETS

255.0

D8999.PP

DENTAL PAYMENT PLAN FEE

300.0

D9110

PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE

158.0

D9120

FIXED PARTIAL DENTURE SECTIONING

70.0

D9210

LOCAL ANESTHESIA NOT IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES

37.0

D9211

REGIONAL BLOCK ANESTHESIA

38.0

D9212

TRIGEMINAL DIVISION BLOCK ANESTHESIA

45.0

D9215

LOCAL ANESTHESIA IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES

240.0

D9219

EVALUATION FOR MOD OR DEEP SEDATION / GA

114.0

D9222

DEEP SEDATION/GENERAL ANESTHESIA - FIRST 15 MINUTES

230.0

D9223

DEEP SEDATION/GENERAL ANESTHESIA - EACH SUBSEQUENT 15 MINUTE INCREMENT

169.0

D9230

INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS

58.0

D9239

INTRAVENOUS MODERATE (CONSCIOUS) SEDATION/ANALGESIA - FIRST 15 MINUTES

134.0

D9243

INTRAVENOUS MODERATE (CONSCIOUS) SEDATION/ANALGESIA - EACH SUBSEQUENT 15 MINUTE INCREMENT

77.0

D9248

NON-INTRAVENOUS CONSCIOUS SEDATION

106.0

D9310

CONSULTATION - DIAGNOSTIC SERVICE PROVIDED BY DENTIST OR PHYSICIAN OTHER THAN REQUESTING DENTIST OR PHYSICIAN

78.0

D9311

CONSULT WITH A MEDICAL HEALTHCARE PROFESSIONAL

164.0

D9410

HOUSE/EXTENDED CARE FACILITY CALL

91.0

D9420

HOSPITAL OR AMBULATORY SURGICAL CENTER CALL

137.0

D9430

OFFICE VISIT FOR OBSERVATION (DURING REGULARLY SCHEDULED HOURS) - NO OTHER SERVICES PERFORMED

67.0

D9440

OFFICE VISIT - AFTER REGULARLY SCHEDULED HOURS

102.0

D9630

DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE

17.0

D9910

APPLICATION OF DESENSITIZING MEDICAMENT

56.0

D9911

APPLICATION OF DESENSITIZING RESIN FOR CERVICAL AND/OR ROOT SURFACE, PER TOOTH

67.0

D9912

PRE-VISIT PATIENT SCREENING

77.0

D9930

TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT

D9932

CLEAN/INSPECT REMOVBL COMPLETE MAXILLARY DENTURE

195.0

D9932

CLEAN/INSPECT REMOVBL COMPLETE MAXILLARY DENTURE

195.0

D9933

CLEAN INSPECT REMVBL COMPLETE MANDIBULAR DENTURE

195.0

D9933

CLEAN INSPECT REMVBL COMPLETE MANDIBULAR DENTURE

195.0

D9934

CLEAN/ INSPECT REMVBL PARTIAL MAXILLARY DENTURE

195.0

D9935

CLEAN INSPECT REMVBL PARTIAL MANDIBULAR DENTURE

195.0

D9940

D9941

FABRICATION OF ATHLETIC MOUTHGUARD

123.0

D9942

REPAIR AND/OR RELINE OF OCCLUSAL GUARD

105.0

D9943

OCCLUSAL GUARD ADJUSTMENT

68.0

D9944

OCCLUSAL GUARD - HARD APPLIANCE, FULL ARCH

392.0

D9945

OCCLUSAL GUARD - SOFT APPLIANCE, FULL ARCH

392.0

D9946

OCCLUSAL GUARD HARD APPLIANCE PARTIAL ARCH

657.0

D9950

OCCLUSION ANALYSIS - MOUNTED CASE

87.0

D9951

OCCLUSAL ADJUSTMENT - LIMITED

257.0

D9952

OCCLUSAL ADJUSTMENT - COMPLETE

459.0

D9953

RELINE CUSTOM SLEEP APNEA APPLIANCE (INDIRECT)

748.0

D9970

ENAMEL MICROABRASION

62.0

D9971

ODONTOPLASTY 1 TO 2 TEETH; INCLUDES REMOVAL OF ENAMEL PROJECTIONS

86.0

D9972

EXTERNAL BLEACHING - PER ARCH - PERFORMED IN OFFICE

168.0

D9972.1

IMPRESSION - EXTERNAL BLEACHING - PER ARCH - PERFORMED IN OFFICE

61.0

D9972.A

REFILLS - EXTERNAL BLEACHING - PER ARCH - PERFORMED IN OFFICE

D9973

EXTERNAL BLEACHING - PER TOOTH

67.0

D9974

INTERNAL BLEACHING - PER TOOTH

201.0

D9975

EXTERNAL BLEACHING FOR HOME APPLICATION

151.0

D9992

DENTAL CASE MANAGEMENT - CARE COORDINATION

79.0

D9995

TELEDENTISTRY - SYNCHRONOUS; REAL TIME ENCOUNTER

363.0

D9996

TELDENTRY ASYNCHRNS INFO FWD DENTIST SBSQNT REVW

272.0

D9999

UNSPECIFIED ADJUNCTIVE PROCEDURE, BY REPORT