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21031 1/1/1990 D M EXCISION OF TORUS MANDIBULARIS
21440 1/1/1985 D M
CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY
ALVEOLAR RIDGE FRACTURE (SEPARATE PROCEDURE)
21445 1/1/1985 D M
OPEN TREATMENT OF MANDIBULAR OR MAXILLARY
ALVEOLAR RIDGE FRACTURE (SEPARATE PROCEDURE)
40806 1/1/1985 D M INCISION OF LABIAL FRENUM (FRENOTOMY)
40819 1/1/1985 D M
EXCISION OF FRENUM, LABIAL OR BUCCAL
(FRENUMECTOMY, FRENULECTOMY, FRENECTOMY)
40840 1/1/1985 D M VESTIBULOPLASTY; ANTERIOR
40842 1/1/1985 D M VESTIBULOPLASTY; POSTERIOR, UNILATERAL
40843 1/1/1985 D M VESTIBULOPLASTY; POSTERIOR, BILATERAL
40844 1/1/1985 D M VESTIBULOPLASTY; ENTIRE ARCH
40845 1/1/1985 D M
VESTIBULOPLASTY; COMPLEX (INCLUDING RIDGE
EXTENSION, MUSCLE REPOSITIONING)
41520 1/1/1985 D M
FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG,
WITH Z-PLASTY)
41820 1/1/1985 D M GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT
41821 1/1/1985 D M OPERCULECTOMY, EXCISION PERICORONAL TISSUES
41822 1/1/1985 D M
EXCISION OF FIBROUS TUBEROSITIES, DENTOALVEOLAR
STRUCTURES
41823 1/1/1985 D M
EXCISION OF OSSEOUS TUBEROSITIES,
DENTOALVEOLAR STRUCTURES
41830 1/1/1985 D M
ALVEOLECTOMY, INCLUDING CURETTAGE OF OSTEITIS
OR SEQUESTRECTOMY
41870 1/1/1985 D M PERIODONTAL MUCOSAL GRAFTING
41872 1/1/1985 D M GINGIVOPLASTY, EACH QUADRANT (SPECIFY)
41874 1/1/1985 D M ALVEOLOPLASTY, EACH QUADRANT (SPECIFY)
D0120 1/1/1985 D M PERIODIC ORAL EVALUATION - ESTABLISHED PATIENT
D0140 1/1/1996 D M LIMITED ORAL EVALUATION - PROBLEM FOCUSED
D0145 1/1/2007 D M
ORAL EVALUATION FOR A PATIENT UNDER THREE
YEARS OF AGE AND COUNSELING WITH PRIMARY
CAREGIVER
The below list of codes are primary dental (D) and should be submitted to United Concordia Dental
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D0150 1/1/1996 D M
COMPREHENSIVE ORAL EVALUATION - NEW OR
ESTABLISHED PATIENT
D0160 1/1/1996 D M
DETAILED AND EXTENSIVE ORAL EVALUATION -
PROBLEM FOCUSED, BY REPORT
D0170 1/1/2000 D M
RE-EVALUATION - LIMITED, PROBLEM FOCUSED
(ESTABLISHED PATIENT; NOT POST-OPERATIVE VISIT)
D0171 1/1/2015 D M RE-EVALUATION - POST-OPERATIVE OFFICE VISIT
D0180 1/1/2003 D M
COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR
ESTABLISHED PATIENT
D0190 1/1/2013 D M SCREENING OF A PATIENT
D0191 1/1/2013 D M ASSESSMENT OF A PATIENT
D0210 1/1/1985 D M
INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC
IMAGES
D0220 1/1/1985 D M INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE
D0230 1/1/1985 D M
INTRAORAL - PERIAPICAL EACH ADDITIONAL
RADIOGRAPHIC IMAGE
D0240 1/1/1985 D M INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE
D0250 1/1/1985 D M
EXTRA-ORAL - 2D PROJECTION RADIOGRAPHIC IMAGE
CREATED USING A STATIONARY RADIATION SOURCE,
AND DETECTOR
D0251 1/1/2016 D M EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE
D0270 1/1/1985 D M BITEWING - SINGLE RADIOGRAPHIC IMAGE.
D0272 1/1/1985 D M BITEWINGS - TWO RADIOGRAPHIC IMAGES.
D0273 1/1/2007 D M BITEWINGS - THREE RADIOGRAPHIC IMAGES
D0274 1/1/1985 D M BITEWINGS - FOUR RADIOGRAPHIC IMAGES.
D0277 1/1/2000 D M VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES
D0310 1/1/1986 D M SIALOGRAPHY
D0320 1/1/1986 D M
TEMPOROMANDIBULAR JOINT ARTHROGRAM, INCLUDING
INJECTION
D0321 1/1/1985 D M
OTHER TEMPOROMANDIBULAR JOINT RADIOGRAPHIC
IMAGES, BY REPORT
D0322 1/1/1992 D M TOMOGRAPHIC SURVEY
D0330 1/1/1985 D M PANORAMIC RADIOGRAPHIC IMAGE
D0340 1/1/1985 D M
2D CEPHALOMETRIC RADIOGRAPHIC IMAGE -
ACQUISITION, MEASUREMENT AND ANALYSIS
D0350 1/1/2000 D M
2D ORAL/FACIAL PHOTOGRAPHIC IMAGE OBTAINED
INTRA-ORALLY OR EXTRA-ORALLY
D0351 1/1/2015 D M 3D PHOTOGRAPHIC IMAGE
D0364 1/1/2013 D M
CONE BEAM CT CAPTURE AND INTERPRETATION WITH
LIMITED FIELD OF VIEW - LESS THAN ONE WHOLE JAW
D0365 1/1/2013 D M
CONE BEAM CT CAPTURE AND INTERPRETATION WITH
FIELD OF VIEW OF ONE FULL DENTAL ARCH - MANDIBLE
D0366 1/1/2013 D M
CONE BEAM CT CAPTURE AND INTERPRETATION WITH
FIELD OF VIEW OF ONE FULL DENTAL ARCH - MAXILLA,
WITH OR WITHOUT CRANIUM
D0367 1/1/2013 D M
CONE BEAM CT CAPTURE AND INTERPRETATION WITH
FIELD OF VIEW OF BOTH JAWS, WITH OR WITHOUT
CRANIUM
D0368 1/1/2013 D M
CONE BEAM CT CAPTURE AND INTERPRETATION FOR
TMJ SERIES INCLUDING TWO OR MORE EXPOSURES
D0369 1/1/2013 D M MAXILLOFACIAL MRI CAPTURE AND INTERPRETATION
D0370 1/1/2013 D M
MAXILLOFACIAL ULTRASOUND CAPTURE AND
INTERPRETATION
D0371 1/1/2013 D M SIALOENDOSCOPY CAPTURE AND INTERPRETATION
D0380 1/1/2013 D M
CONE BEAM CT IMAGE CAPTURE WITH LIMITED FIELD OF
VIEW - LESS THAN ONE WHOLE JAW
D0381 1/1/2013 D M
CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF
ONE FULL DENTAL ARCH - MANDIBLE
D0382 1/1/2013 D M
CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF
ONE FULL DENTAL ARCH - MAXILLA, WITH OR WITHOUT
CRANIUM
D0383 1/1/2013 D M
CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF
BOTH JAWS, WITH OR WITHOUT CRANIUM
D0384 1/1/2013 D M
CONE BEAM CT IMAGE CAPTURE FOR TMJ SERIES
INCLUDING TWO OR MORE EXPOSURES
D0385 1/1/2013 D M MAXILLOFACIAL MRI IMAGE CAPTURE
D0386 1/1/2013 D M MAXILLOFACIAL ULTRASOUND IMAGE CAPTURE
D0391 1/1/2013 D M
INTERPRETATION OF DIAGNOSTIC IMAGE BY A
PRACTITIONER NOT ASSOCIATED WITH CAPTURE OF
THE IMAGE, INCLUDING REPORT
D0393 1/1/2014 D M TREATMENT SIMULATION USING 3D IMAGE VOLUME
D0394 1/1/2014 D M
DIGITAL SUBTRACTION OF TWO OR MORE IMAGES OR
IMAGE VOLUMES OF THE SAME MODALITY
D0395 1/1/2014 D M
FUSION OF TWO OR MORE 3D IMAGE VOLUMES OF ONE
OR MORE MODALITIES
D0411 1/1/2018 D M HBA1C IN-OFFICE POINT OF SERVICE TESTING
D0414 1/1/2017 D M
LABORATORY PROCESSING OF MICROBIAL SPECIMEN TO
INCLUDE CULTURE AND SENSITIVITY STUDIES,
PREPARATION AND TRANSMISSION OF WRITTEN
REPORT
D0415 1/1/1992 D M
COLLECTION OF MICROORGANISMS FOR CULTURE AND
SENSITIVITY
D0416 1/1/2005 D M VIRAL CULTURE
D0417 1/1/2009 D M
COLLECTION AND PREPARATION OF SALIVA SAMPLE
FOR LABORATORY DIAGNOSTIC TESTING
D0418 1/1/2009 D M ANALYSIS OF SALIVA SAMPLE
D0425 1/1/1992 D M CARIES SUSCEPTIBILITY TESTS
D0431 1/1/2005 D M
ADJUNCTIVE PRE-DIAGNOSTIC TEST THAT AIDS IN
DETECTION OF MUCOSAL ABNORMALITIES INCLUDING
PREMALIGNANT AND MALIGNANT LESIONS, NOT TO
INCLUDE CYTOLOGY OR BIOPSY PROCEDURES
D0460 1/1/1985 D M PULP VITALITY TESTS
D0470 1/1/1985 D M DIAGNOSTIC CASTS
D0472 1/1/2000 D M
ACCESSION OF TISSUE, GROSS EXAMINATION,
PREPARATION AND TRANSMISSION OF WRITTEN
REPORT
D0473 1/1/2000 D M
ACCESSION OF TISSUE, GROSS AND MICROSCOPIC
EXAMINATION, PREPARATION AND TRANSMISSION OF
WRITTEN REPORT
D0474 1/1/2000 D M
ACCESSION OF TISSUE, GROSS AND MICROSCOPIC
EXAMINATION, INCLUDING ASSESSMENT OF SURGICAL
MARGINS FOR PRESENCE OF DISEASE, PREPARATION
AND TRANSMISSION OF WRITTEN REPORT
D0475 1/1/2005 D M DECALCIFICATION PROCEDURE
D0476 1/1/2005 D M SPECIAL STAINS FOR MICROORGANISMS
D0477 1/1/2005 D M SPECIAL STAINS, NOT FOR MICROORGANISMS
D0478 1/1/2005 D M IMMUNOHISTOCHEMICAL STAINS
D0479 1/1/2005 D M
TISSUE IN-SITU HYBRIDIZATION, INCLUDING
INTERPRETATION
D0480 1/1/2000 D M
ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS,
MICROSCOPIC EXAMINATION, PREPARATION AND
TRANSMISSION OF WRITTEN REPORT
D0481 1/1/2005 D M ELECTRON MICROSCOPY
D0482 1/1/2005 D M DIRECT IMMUNOFLUORESCENCE
D0483 1/1/2005 D M INDIRECT IMMUNOFLUORESCENCE
D0484 1/1/2005 D M CONSULTATION ON SLIDES PREPARED ELSEWHERE
D0485 1/1/2005 D M
CONSULTATION, INCLUDING PREPARATION OF SLIDES
FROM BIOPSY MATERIAL SUPPLIED BY REFERRING
SOURCE
D0486 1/1/2007 D M
LABORATORY ACCESSION OF TRANSEPITHELIAL
CYTOLOGIC SAMPLE, MICROSCOPIC EXAMINATION,
PREPARATION AND TRANSMISSION OF WRITTEN
REPORT
D0502 1/1/1986 D M OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT
D0600 1/1/2017 D M
NON-IONIZING DIAGNOSTIC PROCEDURE CAPABLE OF
QUANTIFYING, MONITORING, AND RECORDING CHANGES
IN STRUCTURE OF ENAMEL, DENTIN AND CEMENTUM
D0601 1/1/2014 D M
CARIES RISK ASSESSMENT AND DOCUMENTATION, WITH
A FINDING OF LOW RISK
D0602 1/1/2014 D M
CARIES RISK ASSESSMENT AND DOCUMENTATION, WITH
A FINDING OF MODERATE RISK
D0603 1/1/2014 D M
CARIES RISK ASSESSMENT AND DOCUMENTATION, WITH
A FINDING OF HIGH RISK
D0999 1/1/1985 D M UNSPECIFIED DIAGNOSTIC PROCEDURE, BY REPORT
D1110 1/1/1985 D M PROPHYLAXIS - ADULT
D1120 1/1/1985 D M PROPHYLAXIS - CHILD
D1206 1/1/2007 D M TOPICAL APPLICATION OF FLUORIDE VARNISH
D1208 1/1/2013 D M TOPICAL APPLICATION OF FLUORIDE
D1310 1/1/1985 D M
NUTRITIONAL COUNSELING FOR CONTROL OF DENTAL
DISEASE
D1320 1/1/1996 D M
TOBACCO COUNSELING FOR THE CONTROL AND
PREVENTION OF ORAL DISEASE
D1330 1/1/1985 D M ORAL HYGIENE INSTRUCTIONS
D1351 1/1/1985 D M SEALANT - PER TOOTH
D1352 1/1/2011 D M
PREVENTIVE RESIN RESTORATION IN A MODERATE TO
HIGH CARIES RISK PATIENT - PERMANENT TOOTH
D1353 1/1/2015 D M SEALANT REPAIR - PER TOOTH
D1354 1/1/2016 D M
INTERIM CARIES ARRESTING MEDICAMENT APPLICATION -
PER TOOTH
D1510 1/1/1985 D M
SPACE MAINTAINER - FIXED, UNILATERAL - PER
QUADRANT
D1520 1/1/1985 D M
SPACE MAINTAINER - REMOVABLE, UNILATERAL - PER
QUADRANT
D1551 1/1/2020 D M
RE-CEMENT OR RE-BOND BILATERAL SPACE MAINTAINER
- MAXILLARY
D1552 1/1/2020 D M
RE-CEMENT OR RE-BOND BILATERAL SPACE MAINTAINER
- MANDIBULAR
D1553 1/1/2020 D M
RE-CEMENT OR RE-BOND UNILATERAL SPACE
MAINTAINER - PER QUADRANT
D1556 1/1/2020 D M
REMOVAL OF FIXED UNILATERAL SPACE MAINTAINER -
PER QUADRANT
D1557 1/1/2020 D M
REMOVAL OF FIXED BILATERAL SPACE MAINTAINER -
MAXILLARY
D1558 1/1/2020 D M
REMOVAL OF FIXED BILATERAL SPACE MAINTAINER -
MANDIBULAR
D1575 1/1/2017 D M
DISTAL SHOE SPACE MAINTAINER - FIXED, UNILATERAL -
PER QUADRANT
D1999 1/1/2014 D M UNSPECIFIED PREVENTIVE PROCEDURE, BY REPORT
D2140 1/1/1985 D M AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT
D2150 1/1/1985 D M AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT
D2160 1/1/1985 D M
AMALGAM - THREE SURFACES, PRIMARY OR
PERMANENT
D2161 1/1/1985 D M
AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR
PERMANENT
D2330 1/1/1985 D M RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR
D2331 1/1/1985 D M RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR
D2332 1/1/1985 D M
RESIN-BASED COMPOSITE - THREE SURFACES,
ANTERIOR
D2335 1/1/1985 D M
RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES
OR INVOLVING INCISAL ANGLE (ANTERIOR)
D2390 1/1/2003 D M RESIN-BASED COMPOSITE CROWN, ANTERIOR
D2391 1/1/2003 D M RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR
D2392 1/1/2003 D M
RESIN-BASED COMPOSITE - TWO SURFACES,
POSTERIOR
D2393 1/1/2003 D M
RESIN-BASED COMPOSITE - THREE SURFACES,
POSTERIOR
D2394 1/1/2003 D M
RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES,
POSTERIOR
D2410 1/1/1985 D M GOLD FOIL - ONE SURFACE
D2420 1/1/1985 D M GOLD FOIL - TWO SURFACES
D2430 1/1/1985 D M GOLD FOIL - THREE SURFACES
D2510 1/1/1985 D M INLAY - METALLIC - ONE SURFACE
D2520 1/1/1985 D M INLAY - METALLIC - TWO SURFACES
D2530 1/1/1985 D M INLAY - METALLIC - THREE OR MORE SURFACES
D2542 1/1/2000 D M ONLAY - METALLIC - TWO SURFACES
D2543 1/1/1996 D M ONLAY - METALLIC - THREE SURFACES
D2544 1/1/1996 D M ONLAY - METALLIC - FOUR OR MORE SURFACES
D2610 1/1/1985 D M INLAY - PORCELAIN/CERAMIC - ONE SURFACE
D2620 1/1/1986 D M INLAY - PORCELAIN/CERAMIC - TWO SURFACES
D2630 1/1/1986 D M
INLAY - PORCELAIN/CERAMIC - THREE OR MORE
SURFACES
D2642 1/1/1996 D M ONLAY - PORCELAIN/CERAMIC - TWO SURFACES
D2643 1/1/1996 D M ONLAY - PORCELAIN/CERAMIC - THREE SURFACES
D2644 1/1/1996 D M
ONLAY - PORCELAIN/CERAMIC - FOUR OR MORE
SURFACES
D2650 1/1/1992 D M INLAY - RESIN-BASED COMPOSITE - ONE SURFACE
D2651 1/1/1992 D M INLAY - RESIN-BASED COMPOSITE - TWO SURFACES
D2652 1/1/1992 D M
INLAY - RESIN-BASED COMPOSITE - THREE OR MORE
SURFACES
D2662 1/1/1996 D M ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES
D2663 1/1/1996 D M ONLAY - RESIN-BASED COMPOSITE - THREE SURFACES
D2664 1/1/1996 D M
ONLAY - RESIN-BASED COMPOSITE - FOUR OR MORE
SURFACES
D2710 1/1/1985 D M CROWN - RESIN-BASED COMPOSITE (INDIRECT)
D2712 1/1/2005 D M CROWN - 3/4 RESIN-BASED COMPOSITE (INDIRECT)
D2720 1/1/1985 D M CROWN - RESIN WITH HIGH NOBLE METAL
D2721 1/1/1985 D M CROWN - RESIN WITH PREDOMINANTLY BASE METAL
D2722 1/1/1985 D M CROWN - RESIN WITH NOBLE METAL
D2740 1/1/1985 D M CROWN - PORCELAIN/CERAMIC
D2750 1/1/1985 D M CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL
D2751 1/1/1986 D M
CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE
METAL
D2752 1/1/1985 D M CROWN - PORCELAIN FUSED TO NOBLE METAL
D2753 1/1/2020 D M
CROWN - PORCELAIN FUSED TO TITANIUM AND TITANIUM
ALLOYS
D2780 1/1/2000 D M CROWN - 3/4 CAST HIGH NOBLE METAL
D2781 1/1/2000 D M CROWN - 3/4 CAST PREDOMINANTLY BASE METAL
D2782 1/1/2000 D M CROWN - 3/4 CAST NOBLE METAL
D2783 1/1/2000 D M CROWN - 3/4 PORCELAIN/CERAMIC
D2790 1/1/1985 D M CROWN - FULL CAST HIGH NOBLE METAL
D2791 1/1/1985 D M CROWN - FULL CAST PREDOMINANTLY BASE METAL
D2792 1/1/1985 D M CROWN - FULL CAST NOBLE METAL
D2794 1/1/2005 D M CROWN - TITANIUM AND TITANIUM ALLOYS
D2799 1/1/2000 D M
PROVISIONAL CROWN - FURTHER TREATMENT OR
COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO
FINAL IMPRESSION
D2910 1/1/1985 D M
RECEMENT INLAY, ONLAY, OR PARTIAL COVERAGE
RESTORATION
D2915 1/1/2005 D M
RE-CEMENT OR RE-BOND INDIRECTLY FABRICATED OR
PREFABRICATED POST AND CORE
D2920 1/1/1985 D M RE-CEMENT OR RE-BOND CROWN
D2921 1/1/2014 D M
REATTACHMENT OF TOOTH FRAGMENT, INCISAL EDGE
OR CUSP
D2929 1/1/2013 D M
PREFABRICATED PORCELAIN/CERAMIC CROWN -
PRIMARY TOOTH
D2930 1/1/1986 D M
PREFABRICATED STAINLESS STEEL CROWN - PRIMARY
TOOTH
D2931 1/1/1986 D M
PREFABRICATED STAINLESS STEEL CROWN -
PERMANENT TOOTH
D2932 1/1/1986 D M PREFABRICATED RESIN CROWN
D2933 1/1/1992 D M
PREFABRICATED STAINLESS STEEL CROWN WITH RESIN
WINDOW
D2934 1/1/2005 D M
PREFABRICATED ESTHETIC COATED STAINLESS STEEL
CROWN - PRIMARY TOOTH
D2940 1/1/1985 D M PROTECTIVE RESTORATION
D2941 1/1/2014 D M
INTERIM THERAPEUTIC RESTORATION - PRIMARY
DENTITION
D2949 1/1/2014 D M
RESTORATIVE FOUNDATION FOR AN INDIRECT
RESTORATION
D2950 1/1/1986 D M CORE BUILDUP, INCLUDING ANY PINS WHEN REQUIRED
D2951 1/1/1986 D M
PIN RETENTION - PER TOOTH, IN ADDITION TO
RESTORATION
D2952 1/1/1986 D M
POST AND CORE IN ADDITION TO CROWN, INDIRECTLY
FABRICATED
D2953 1/1/2000 D M
EACH ADDITIONAL INDIRECTLY FABRICATED POST -
SAME TOOTH
D2954 1/1/1986 D M
PREFABRICATED POST AND CORE IN ADDITION TO
CROWN
D2955 1/1/1996 D M POST REMOVAL
D2957 1/1/2000 D M EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH
D2960 1/1/1985 D M LABIAL VENEER (RESIN LAMINATE) - CHAIRSIDE
D2961 1/1/1992 D M LABIAL VENEER (RESIN LAMINATE) - LABORATORY
D2962 1/1/1992 D M LABIAL VENEER (PORCELAIN LAMINATE) - LABORATORY
D2971 1/1/2005 D M
ADDITIONAL PROCEDURES TO CONSTRUCT NEW
CROWN UNDER EXISTING PARTIAL DENTURE
FRAMEWORK
D2975 1/1/2005 D M COPING
D2980 1/1/1986 D M
CROWN REPAIR NECESSITATED BY RESTORATIVE
MATERIAL FAILURE
D2981 1/1/2013 D M
INLAY REPAIR NECESSITATED BY RESTORATIVE
MATERIAL FAILURE
D2982 1/1/2013 D M
ONLAY REPAIR NECESSITATED BY RESTORATIVE
MATERIAL FAILURE
D2983 1/1/2013 D M
VENEER REPAIR NECESSITATED BY RESTORATIVE
MATERIAL FAILURE
D2990 1/1/2013 D M
RESIN INFILTRATION OF INCIPIENT SMOOTH SURFACE
LESIONS
D2999 1/1/1986 D M UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT
D3110 1/1/1985 D M PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)
D3120 1/1/1985 D M PULP CAP - INDIRECT (EXCLUDING FINAL RESTORATION)
D3220 1/1/1985 D M
THERAPEUTIC PULPOTOMY (EXCLUDING FINAL
RESTORATION)- REMOVAL OF PULP CORONAL TO THE
DENTINOCEMENTAL JUNCTION AND APPLICATION OF
MEDICAMENT
D3221 1/1/2000 D M
PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT
TEETH
D3222 1/1/2009 D M
PARTIAL PULPOTOMY FOR APEXOGENESIS -
PERMANENT TOOTH WITH INCOMPLETE ROOT
DEVELOPMENT
D3230 1/1/1996 D M
PULPAL THERAPY (RESORBABLE FILLING) - ANTERIOR,
PRIMARY TOOTH (EXCLUDING FINAL RESTORATION)
D3240 1/1/1996 D M
PULPAL THERAPY (RESORBABLE FILLING) - POSTERIOR,
PRIMARY TOOTH (EXCLUDING FINAL RESTORATION)
D3310 1/1/1985 D M
ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING
FINAL RESTORATION)
D3330 1/1/1985 D M
ENDODONTIC THERAPY, MOLAR TOOTH (EXCLUDING
FINAL RESTORATIONS)
D3331 1/1/2000 D M
TREATMENT OF ROOT CANAL OBSTRUCTION; NON-
SURGICAL ACCESS
D3332 1/1/2000 D M
INCOMPLETE ENDODONTIC THERAPY; INOPERABLE
UNRESTORABLE OR FRACTURED TOOTH
D3333 1/1/2000 D M INTERNAL ROOT REPAIR OF PERFORATION DEFECTS
D3346 1/1/1992 D M
RETREATMENT OF PREVIOUS ROOT CANAL THERAPY -
ANTERIOR
D3348 1/1/1992 D M
RETREATMENT OF PREVIOUS ROOT CANAL THERAPY -
MOLAR
D3351 1/1/1992 D M
APEXIFICATION/RECALCIFICATION - INITIAL VISIT (APICAL
CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT
RESORPTION, ETC.)
D3352 1/1/1992 D M
APEXIFICATION/RECALCIFICATION - INTERIM MEDICATION
REPLACEMENT (APICAL CLOSURE/CALCIFIC REPAIR OF
PERFORATIONS, ROOT RESORPTION, PULPAL SPACE
DISINFECTION, ETC.)
D3353 1/1/1992 D M
APEXIFICATION/RECALCIFICATION-FINAL VISIT
(INCLUDES COMPLETED ROOT CANAL THERAPY-APICAL
CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT
RESORPTION, ETC.)
D3355 1/1/2014 D M PULPAL REGENERATION - INITIAL VISIT
D3356 1/1/2014 D M
PULPAL REGENERATION - INTERIM MEDICATION
REPLACEMENT
D3357 1/1/2014 D M PULPAL REGENERATION - COMPLETION OF TREATMENT
D3410 1/1/1985 D M APICOECTOMY - ANTERIOR
D3425 1/1/1992 D M APICOECTOMY - MOLAR (FIRST ROOT)
D3426 1/1/1992 D M APICOECTOMY (EACH ADDITIONAL ROOT)
D3427 1/1/2014 D M PERIRADICULAR SURGERY WITHOUT APICOECTOMY
D3428 1/1/2014 D M
BONE GRAFT IN CONJUNCTION WITH PERIRADICULAR
SURGERY - PER TOOTH, SINGLE SITE
D3429 1/1/2014 D M
BONE GRAFT IN CONJUNCTION WITH PERIRADICULAR
SURGERY - EACH ADDITIONAL CONTIGUOUS TOOTH IN
THE SAME SURGICAL SITE
D3430 1/1/1985 D M RETROGRADE FILLING - PER ROOT
D3431 1/1/2014 D M
BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS
TISSUE REGENERATION IN CONJUNCTION WITH
PERIRADICULAR SURGERY
D3432 1/1/2014 D M
GUIDED TISSUE REGENERATION, RESORBABLE
BARRIER, PER SITE, IN CONJUNCTION WITH
PERIRADICULAR SURGERY
D3450 1/1/1985 D M ROOT AMPUTATION - PER ROOT
D3460 1/1/1985 D M ENDODONTIC/ENDOSSEOUS IMPLANTS
D3470 1/1/1992 D M
INTENTIONAL REIMPLANTATION (INCLUDING NECESSARY
SPLINTING)
D3910 1/1/1985 D M
SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH
RUBBER DAM
D3920 1/1/1985 D M
HEMISECTION (INCLUDING ANY ROOT REMOVAL) NOT
INCLUDING ROOT CANAL THERAPY
D3950 1/1/1985 D M
CANAL PREPARATION AND FITTING OF PREFORMED
DOWEL OR POST
D3999 1/1/1985 D M UNSPECIFIED ENDODONTIC PROCEDURE (BY REPORT)
D4210 1/1/1985 D M
GINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE
CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER
QUADRANT
D4211 1/1/1986 D M
GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE
CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER
QUADRANT
D4212 1/1/2013 D M
GINGIVECTOMY OR GINGIVOPLASTY TO ALLOW ACCESS
FOR RESTORATIVE PROCEDURE, PER TOOTH
D4230 1/1/2007 D M
ANATOMICAL CROWN EXPOSURE - FOUR OR MORE
CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER
QUADRANT
D4231 1/1/2007 D M
ANATOMICAL CROWN EXPOSURE - ONE TO THREE
TEETH OR TOOTH BOUNDED SPACES PER QUADRANT
D4240 1/1/1985 D M
GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING -
FOUR OR MORE CONTIGUOUS TEETH OR TOOTH
BOUNDED SPACES PER QUADRANT
D4241 1/1/2003 D M
GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING -
ONE TO THREE CONTIGUOUS TEETH OR TOOTH
BOUNDED SPACES PER QUADRANT
D4245 1/1/2000 D M APICALLY POSITIONED FLAP
D4249 1/1/1992 D M CLINICAL CROWN LENGTHENING-HARD TISSUE
D4260 1/1/1985 D M
OSSEOUS SURGERY (INCLUDING ELEVATION OF A FULL
THICKNESS FLAP AND CLOSURE) - FOUR OR MORE
CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER
QUADRANT
D4261 1/1/2003 D M
OSSEOUS SURGERY (INCLUDING ELEVATION OF A FULL
THICKNESS FLAP AND CLOSURE) - ONE TO THREE
CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER
QUADRANT
D4263 1/1/1996 D M
BONE REPLACEMENT GRAFT - RETAINED NATURAL
TOOTH - FIRST SITE IN QUADRANT
D4264 1/1/1996 D M
BONE REPLACEMENT GRAFT - RETAINED NATURAL
TOOTH - EACH ADDITIONAL SITE IN QUADRANT
D4265 1/1/2003 D M
BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS
TISSUE REGENERATION
D4266 1/1/1996 D M
GUIDED TISSUE REGENERATION - RESORBABLE
BARRIER, PER SITE
D4267 1/1/1996 D M
GUIDED TISSUE REGENERATION - NONRESORBABLE
BARRIER, PER SITE, (INCLUDES MEMBRANE REMOVAL)
D4268 1/1/2000 D M SURGICAL REVISION PROCEDURE, PER TOOTH
D4270 1/1/1985 D M PEDICLE SOFT TISSUE GRAFT PROCEDURE
D4273 1/1/1996 D M
AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE
(INCLUDING DONOR AND RECIPIENT SURGICAL SITES)
FIRST TOOTH, IMPLANT, OR EDENTULOUS TOOTH
POSITION IN GRAFT
D4274 1/1/1996 D M
MESIAL/DISTAL WEDGE PROCEDURE, SINGLE TOOTH
(WHEN NOT PERFORMED IN CONJUNCTION WITH
SURGICAL PROCEDURES IN THE SAME ANATOMICAL
AREA)
D4275 1/1/2003 D M
NON-AUTOGENOUS CONNECTIVE TISSUE GRAFT
(INCLUDING RECIPIENT SITE AND DONOR MATERIAL)
FIRST TOOTH, IMPLANT, OR EDENTULOUS TOOTH
POSITION IN GRAFT
D4276 1/1/2003 D M
COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE
GRAFT, PER TOOTH
D4277 1/1/2013 D M
FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING
RECIPIENT AND DONOR SURGICAL SITES) FIRST TOOTH,
IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT
D4278 1/1/2013 D M
FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING
RECIPIENT AND DONOR SURGICAL SITES) EACH
ADDITIONAL CONTIGUOUS TOOTH, IMPLANT, OR
EDENTULOUS TOOTH POSITION IN SAME GRAFT SITE
D4283 1/1/2016 D M
AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE
(INCLUDING DONOR AND RECIPIENT SURGICAL SITES) -
EACH ADDITIONAL CONTIGUOUS TOOTH, IMPLANT OR
EDENTULOUS TOOTH POSITION IN SAME GRAFT SITE
D4285 1/1/2016 D M
NON-AUTOGENOUS CONNECTIVE TISSUE GRAFT
PROCEDURE (INCLUDING RECIPIENT SURGICAL SITE AND
DONOR MATERIAL) - EACH ADDITIONAL CONTIGUOUS
TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN
SAME GRAFT SITE
D4320 1/1/1985 D M PROVISIONAL SPLINTING - INTRACORONAL
D4321 1/1/1985 D M PROVISIONAL SPLINTING - EXTRACORONAL
D4341 1/1/1985 D M
PERIODONTAL SCALING AND ROOT PLANING - FOUR OR
MORE TEETH PER QUADRANT
D4342 1/1/2003 D M
PERIODONTAL SCALING AND ROOT PLANING - ONE TO
THREE TEETH PER QUADRANT
D4346 1/1/2017 D M
SCALING IN PRESENCE OF GENERALIZED MODERATE OR
SEVERE GINGIVAL INFLAMMATION FULL MOUTH, AFTER
ORAL EVALUATION
D4355 1/1/1996 D M
FULL MOUTH DEBRIDEMENT TO ENABLE A
COMPREHENSIVE ORAL EVALUATION AND DIAGNOSIS
ON A SUBSEQUENT VISIT
D4381 1/1/1996 D M
LOCALIZED DELIVERY OF ANTIMICROBIAL AGENTS VIA
CONTROLLED RELEASE VEHICLE INTO DISEASED
CREVICULAR TISSUE, PER TOOTH
D4910 1/1/1985 D M PERIODONTAL MAINTENANCE
D4920 1/1/1985 D M
UNSCHEDULED DRESSING CHANGE (BY SOMEONE
OTHER THAN TREATING DENTIST OR THEIR STAFF)
D4921 1/1/2014 D M GINGIVAL IRRIGATION - PER QUADRANT
D4999 1/1/1985 D M UNSPECIFIED PERIODONTAL PROCEDURE, BY REPORT
D5110 1/1/1985 D M COMPLETE DENTURE - MAXILLARY
D5120 1/1/1985 D M COMPLETE DENTURE - MANDIBULAR
D5130 1/1/1985 D M IMMEDIATE DENTURE - MAXILLARY
D5140 1/1/1985 D M IMMEDIATE DENTURE - MANDIBULAR
D5211 1/1/1985 D M
MAXILLARY PARTIAL DENTURE - RESIN BASE (INCLUDING
ANY CONVENTIONAL CLASPS, RESTS AND TEETH)
D5212 1/1/1985 D M
MANDIBULAR PARTIAL DENTURE - RESIN BASE
(INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND
TEETH)
D5213 1/1/1985 D M
MAXILLARY PARTIAL DENTURE - CAST METAL
FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING
RETENTIVE/CLASPING MATERIALS, RESTS AND TEETH)
D5214 1/1/1985 D M
MANDIBULAR PARTIAL DENTURE - CAST METAL
FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING
RETENTIVE/CLASPING MATERIALS, RESTS AND TEETH)
D5221 1/1/2016 D M
IMMEDIATE MAXILLARY PARTIAL DENTURE - RESIN BASE
(INCLUDING RETENTIVE/CLASPING MATERIALS, RESTS
AND TEETH)
D5222 1/1/2016 D M
IMMEDIATE MANDIBULAR PARTIAL DENTURE - RESIN
BASE (INCLUDING RETENTIVE/CLASPING MATERIALS,
RESTS AND TEETH)
D5223 1/1/2016 D M
IMMEDIATE MAXILLARY PARTIAL DENTURE - CAST METAL
FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING
RETENTIVE/CLASPING MATERIALS, RESTS AND TEETH)
D5224 1/1/2016 D M
IMMEDIATE MANDIBULAR PARTIAL DENTURE - CAST
METAL FRAMEWORK WITH RESIN DENTURE BASES
(INCLUDING RETENTIVE/CLASPING MATERIALS, RESTS
AND TEETH)
D5225 1/1/2005 D M
MAXILLARY PARTIAL DENTURE - FLEXIBLE BASE
(INCLUDING ANY CLASPS, RESTS AND TEETH)
D5226 1/1/2005 D M
MANDIBULAR PARTIAL DENTURE - FLEXIBLE BASE
(INCLUDING ANY CLASPS, RESTS AND TEETH)
D5280 1/1/1987 D M
REMOVABLE LOWER UNILATERAL PARTIAL - ONE
DENTURE, ONE PIECE CAST METAL - PER
D5282 1/1/1987 D M
REMOVEABLE UNILATERAL PARTIAL DENTURE - ONE
PIECE CAST METAL (INCLUDING CLASPS AND TEETH),
MAXILLARY
D5283 1/1/2019 D M
REMOVEABLE UNILATERAL PARTIAL DENTURE - ONE
PIECE CAST METAL (INCLUDING CLASPS AND TEETH),
MANDIBULAR
D5284 1/1/2020 D M
REMOVABLE UNILATERAL PARTIAL DENTURE - ONE
PIECE FLEXIBLE BASE (INCLUDING CLASPS AND TEETH) -
PER QUADRANT
D5286 1/1/2020 D M
REMOVABLE UNILATERAL PARTIAL DENTURE - ONE
PIECE RESIN (INCLUDING CLASPS AND TEETH) - PER
QUADRANT
D5410 1/1/1985 D M ADJUST COMPLETE DENTURE - MAXILLARY
D5411 1/1/1986 D M ADJUST COMPLETE DENTURE - MANDIBULAR
D5421 1/1/1985 D M ADJUST PARTIAL DENTURE - MAXILLARY
D5422 1/1/1985 D M ADJUST PARTIAL DENTURE - MANDIBULAR
D5511 1/1/2018 D M
REPAIR BROKEN COMPLETE DENTURE BASE,
MANDIBULAR
D5512 1/1/2018 D M REPAIR BROKEN COMPLETE DENTURE BASE, MAXILLARY
D5520 1/1/1986 D M
REPLACE MISSING OR BROKEN TEETH - COMPLETE
DENTURE (EACH TOOTH)
D5611 1/1/2018 D M REPAIR RESIN PARTIAL DENTURE BASE, MANDIBULAR
D5612 1/1/2018 D M REPAIR RESIN PARTIAL DENTURE BASE, MAXILLARY
D5621 1/1/2018 D M REPAIR CAST PARTIAL FRAMEWORK, MANDIBULAR
D5622 1/1/2018 D M REPAIR CAST PARTIAL FRAMEWORK, MANDIBULAR
D5630 1/1/1985 D M
REPAIR OR REPLACE BROKEN RETENTIVE CLASPING
MATERIALS - PER TOOTH
D5640 1/1/1985 D M REPLACE BROKEN TEETH - PER TOOTH
D5650 1/1/1985 D M ADD TOOTH TO EXISTING PARTIAL DENTURE
D5660 1/1/1985 D M
ADD CLASP TO EXISTING PARTIAL DENTURE - PER
TOOTH
D5670 1/1/2003 D M
REPLACE ALL TEETH AND ACRYLIC ON CAST METAL
FRAMEWORK (MAXILLARY)
D5671 1/1/2003 D M
REPLACE ALL TEETH AND ACRYLIC ON CAST METAL
FRAMEWORK (MANDIBULAR)
D5710 1/1/1985 D M REBASE COMPLETE MAXILLARY DENTURE
D5711 1/1/1986 D M REBASE COMPLETE MANDIBULAR DENTURE
D5720 1/1/1985 D M REBASE MAXILLARY PARTIAL DENTURE
D5721 1/1/1986 D M REBASE MANDIBULAR PARTIAL DENTURE
D5730 1/1/1985 D M RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)
D5731 1/1/1986 D M RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)
D5740 1/1/1985 D M RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE)
D5741 1/1/1986 D M RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE)
D5750 1/1/1985 D M RELINE COMPLETE MAXILLARY DENTURE (LABORATORY)
D5751 1/1/1986 D M
RELINE COMPLETE MANDIBULAR DENTURE
(LABORATORY)
D5760 1/1/1985 D M RELINE MAXILLARY PARTIAL DENTURE (LABORATORY)
D5761 1/1/1986 D M RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY)
D5810 1/1/1985 D M INTERIM COMPLETE DENTURE (MAXILLARY)
D5811 1/1/1985 D M INTERIM COMPLETE DENTURE (MANDIBULAR)
D5820 1/1/1985 D M INTERIM PARTIAL DENTURE (MAXILLARY)
D5821 1/1/1985 D M INTERIM PARTIAL DENTURE (MANDIBULAR)
D5850 1/1/1985 D M TISSUE CONDITIONING, MAXILLARY
D5851 1/1/1992 D M TISSUE CONDITIONING, MANDIBULAR
D5862 1/1/1986 D M PRECISION ATTACHMENT, BY REPORT
D5863 1/1/2014 D M OVERDENTURE - COMPLETE MAXILLARY
D5864 1/1/2014 D M OVERDENTURE - PARTIAL MAXILLARY
D5865 1/1/2014 D M OVERDENTURE - COMPLETE MANDIBULAR
D5866 1/1/2014 D M OVERDENTURE - PARTIAL MANDIBULAR
D5867 1/1/2000 D M
REPLACEMENT OF REPLACEABLE PART OF SEMI-
PRECISION OR PRECISION ATTACHMENT (MALE OR
FEMALE COMPONENT)
D5875 1/1/2000 D M
MODIFICATION OF REMOVABLE PROSTHESIS
FOLLOWING IMPLANT SURGERY
D5876 1/1/2019 D M
ADD METAL SUBSTRUCTURE TO ACYRLIC FULL DENTURE
(PER ARCH)
D5899 1/1/1986 D M
UNSPECIFIED REMOVABLE PROSTHODONTIC
PROCEDURE, BY REPORT
D5911 1/1/1985 D M FACIAL MOULAGE (SECTIONAL)
D5912 1/1/1985 D M FACIAL MOULAGE (COMPLETE)
D5913 1/1/1985 D M NASAL PROSTHESIS
D5914 1/1/1985 D M AURICULAR PROSTHESIS
D5915 1/1/1985 D M ORBITAL PROSTHESIS
D5916 1/1/1985 D M OCULAR PROSTHESIS
D5919 1/1/1985 D M FACIAL PROSTHESIS
D5922 1/1/1992 D M NASAL SEPTAL PROSTHESIS
D5923 1/1/1992 D M OCULAR PROSTHESIS, INTERIM
D5924 1/1/1992 D M CRANIAL PROSTHESIS
D5925 1/1/1992 D M FACIAL AUGMENTATION IMPLANT PROSTHESIS
D5926 1/1/1992 D M NASAL PROSTHESIS, REPLACEMENT
D5927 1/1/1992 D M AURICULAR PROSTHESIS, REPLACEMENT
D5928 1/1/1992 D M ORBITAL PROSTHESIS, REPLACEMENT
D5929 1/1/1992 D M FACIAL PROSTHESIS, REPLACEMENT
D5931 1/1/1985 D M OBTURATOR PROSTHESIS, SURGICAL
D5932 1/1/1985 D M OBTURATOR PROSTHESIS, DEFINITIVE
D5933 1/1/1985 D M OBTURATOR PROSTHESIS, MODIFICATION
D5934 1/1/1985 D M
MANDIBULAR RESECTION PROSTHESIS WITH GUIDE
FLANGE
D5935 1/1/1985 D M
MANDIBULAR RESECTION PROSTHESIS WITHOUT GUIDE
FLANGE
D5936 1/1/1992 D M OBTURATOR PROSTHESIS, INTERIM
D5937 1/1/1992 D M TRISMUS APPLIANCE (NOT FOR TMD TREATMENT)
D5951 1/1/1985 D M FEEDING AID
D5952 1/1/1985 D M SPEECH AID PROSTHESIS, PEDIATRIC
D5953 1/1/1985 D M SPEECH AID PROSTHESIS, ADULT
D5954 1/1/1985 D M PALATAL AUGMENTATION PROSTHESIS
D5955 1/1/1985 D M PALATAL LIFT PROSTHESIS, DEFINITIVE
D5958 1/1/1992 D M PALATAL LIFT PROSTHESIS, INTERIM
D5959 1/1/1992 D M PALATAL LIFT PROSTHESIS, MODIFICATION
D5960 1/1/1992 D M SPEECH AID PROSTHESIS, MODIFICATION
D5982 1/1/1985 D M SURGICAL STENT
D5983 1/1/1985 D M RADIATION CARRIER
D5984 1/1/1985 D M RADIATION SHIELD
D5985 1/1/1985 D M RADIATION CONE LOCATOR
D5986 1/1/1985 D M FLUORIDE GEL CARRIER
D5987 1/1/1992 D M COMMISSURE SPLINT
D5988 1/1/1992 D M SURGICAL SPLINT
D5991 1/1/2009 D M VESICULOBULLOUS DISEASE MEDICAMENT CARRIER
D5992 1/1/2011 D M
ADJUST MAXILLOFACIAL PROSTHETIC APPLIANCE, BY
REPORT
D5993 1/1/2011 D M
MAINTENANCE AND CLEANING OF A MAXILLOFACIAL
PROSTHESIS (EXTRA OR INTRAORAL) OTHER THAN
REQUIRED ADJUSTMENTS, BY REPORT
D5994 1/1/2014 D M
PERIODONTAL MEDICAMENT CARRIER WITH PERIPHERAL
SEAL - LABORATORY PROCESSED
D5999 1/1/1986 D M UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT
D6010 1/1/1996 D M
SURGICAL PLACEMENT OF IMPLANT BODY: ENDOSTEAL
IMPLANT
D6011 1/1/2014 D M SECOND STAGE IMPLANT SURGERY
D6012 1/1/2007 D M
SURGICAL PLACEMENT OF INTERIM IMPLANT BODY FOR
TRANSITIONAL PROSTHESIS: ENDOSTEAL IMPLANT
D6013 1/1/2014 D M SURGICAL PLACEMENT OF MINI IMPLANT
D6040 1/1/1992 D M SURGICAL PLACEMENT: EPOSTEAL IMPLANT
D6050 1/1/1992 D M SURGICAL PLACEMENT: TRANSOSTEAL IMPLANT
D6051 1/1/2013 D M INTERIM ABUTMENT
D6052 1/1/2014 D M SEMI-PRECISION ATTACHMENT ABUTMENT
D6055 1/1/1992 D M
CONNECTING BAR - IMPLANT SUPPORTED OR ABUTMENT
SUPPORTED
D6056 1/1/2000 D M
PREFABRICATED ABUTMENT - INCLUDES MODIFICATION
AND PLACEMENT
D6057 1/1/2000 D M
CUSTOM FABRICATED ABUTMENT - INCLUDES
PLACEMENT
D6058 1/1/2000 D M ABUTMENT SUPPORTED PORCELAIN/CERAMIC CROWN
D6059 1/1/2000 D M ABUTMENT SUPPORTED PROCELAIN/CERAMIC CROWN
D6060 1/1/2000 D M
ABUTMENT SUPPORTED PROCELAIN FUSED TO METAL
CROWN (PREDOMINANTLY BASE METAL)
D6061 1/1/2000 D M
ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL
CROWN (NOBLE METAL)
D6062 1/1/2000 D M
ABUTMENT SUPPORTED CAST METAL CROWN (HIGH
NOBLE METAL)
D6063 1/1/2000 D M
ABUTMENT SUPPORTED CAST METAL CROWN
(PREDOMINANTLY BASE METAL)
D6064 1/1/2000 D M
ABUTMENT SUPPORTED CAST METAL CROWN (NOBLE
METAL)
D6065 1/1/2000 D M IMPLANT SUPPORTED PROCELAIN/CERAMIC CROWN
D6066 1/1/2000 D M
IMPLANT SUPPORTED CROWN - PORCELAIN FUSED TO
HIGH NOBLE ALLOYS
D6067 1/1/2000 D M IMPLANT SUPPORTED CROWN - HIGH NOBLE ALLOYS
D6068 1/1/2000 D M
ABUTMENT SUPPORTED RETAINER FOR
PROCELAIN/CERAMIC FPD
D6069 1/1/2000 D M
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN
FUSED TO METAL FPD (HIGH NOBLE METAL)
D6070 1/1/2000 D M
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN
FUSED TO METAL FPD (PREDOMINANTLY BASE METAL)
D6071 1/1/2000 D M
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN
FUSED TO METAL FPD (NOBLE METAL)
D6072 1/1/2000 D M
ABUTMENT SUPPORTED RETAINER FOR CAST METAL
FPD (HIGH NOBLE METAL)
D6073 1/1/2000 D M
ABUTMENT SUPPORTED RETAINER FOR CAST METAL
FPD (PREDOMINANTLY BASE METAL)
D6074 1/1/2000 D M
ABUTMENT SUPPORTED RETAINER FOR CAST METAL
FPD (NOBLE METAL)
D6075 1/1/2000 D M IMPLANT SUPPORTED RETAINER FOR CERAMIC FPD
D6076 1/1/2000 D M
IMPLANT SUPPORTED RETAINER FOR FPD - PORCELAIN
FUSED TO HIGH NOBLE ALLOYS
D6077 1/1/2000 D M
IMPLANT SUPPORTED RETAINER FOR METAL FPD - HIGH
NOBLE ALLOYS
D6080 1/1/1992 D M
IMPLANT MAINTENANCE PROCEDURES WHEN
PROSTHESES ARE REMOVED AND REINSERTED,
INCLUDING CLEANSING OF PROSTHESES AND
ABUTMENTS
D6081 1/1/2017 D M
SCALING AND DEBRIDEMENT IN THE PRESENCE OF
INFLAMMATION OR MUCOSITIS OF A SINGLE IMPLANT,
INCLUDING CLEANING OF THE IMPLANT SURFACES,
WITHOUT FLAP ENTRY AND CLOSURE
D6082 1/1/2020 D M
IMPLANT SUPPORTED CROWN - PORCELAIN FUSED TO
PREDOMINANTLY BASE ALLOYS
D6083 1/1/2020 D M
IMPLANT SUPPORTED CROWN - PORCELAIN FUSED TO
NOBLE ALLOYS
D6084 1/1/2020 D M
IMPLANT SUPPORTED CROWN - PORCELAIN FUSED TO
TITANIUM AND TITANIUM ALLOYS
D6085 1/1/2017 D M PROVISIONAL IMPLANT CROWN
D6086 1/1/2020 D M
IMPLANT SUPPORTED CROWN - PREDOMINANTLY BASE
ALLOYS
D6087 1/1/2020 D M IMPLANT SUPPORTED CROWN - NOBLE ALLOYS
D6088 1/1/2020 D M
IMPLANT SUPPORTED CROWN - TITANIUM AND TITANIUM
ALLOYS
D6090 1/1/1992 D M REPAIR IMPLANT SUPPORTED PROSTHESIS, BY REPORT
D6091 1/1/2007 D M
REPLACEMENT OF SEMI-PRECISION OR PRECISION
ATTACHMENT (MALE OR FEMALE COMPONENT) OF
IMPLANT/ABUTMENT SUPPORTED PROSTHESIS, PER
ATTACHMENT
D6092 1/1/2007 D M
RE-CEMENT OR RE-BOND IMPLANT/ABUTMENT
SUPPORTED CROWN
D6093 1/1/2007 D M
RE-CEMENT OR RE-BOND IMPLANT/ABUTMENT
SUPPORTED FIXED PARTIAL DENTURE
D6094 1/1/2005 D M
ABUTMENT SUPPORTED CROWN - TITANIUM AND
TITANIUM ALLOYS
D6095 1/1/1996 D M REPAIR IMPLANT ABUTMENT, BY REPORT
D6096 1/1/2018 D M REMOVE BROKEN IMPLANT RETAINING SCREW
D6097 1/1/2020 D M
ABUTMENT SUPPORTED CROWN - PORCELAIN FUSED TO
TITANIUM AND TITANIUM ALLOYS
D6098 1/1/2020 D M
IMPLANT SUPPORTED RETAINER - PORCELAIN FUSED TO
PREDOMINANTLY BASE ALLOYS
D6099 1/1/2020 D M
IMPLANT SUPPORTED RETAINER FOR FPD - PORCELAIN
FUSED TO NOBLE ALLOYS
D6100 1/1/1992 D M IMPLANT REMOVAL, BY REPORT
D6101 1/1/2013 D M
DEBRIDEMENT OF A PERIIMPLANT DEFECT OR DEFECTS
SURROUNDING A SINGLE IMPLANT, AND SURFACE
CLEANING OF THE EXPOSED IMPLANT SURFACES,
INCLUDING FLAP ENTRY AND CLOSURE
D6102 1/1/2013 D M
DEBRIDEMENT AND OSSEOUS CONTOURING OF A
PERIIMPLANT DEFECT OR DEFECTS SURROUNDING A
SINGLE IMPLANT, AND INCLUDES SURFACE CLEANING
OF THE EXPOSED IMPLANT SURFACES, INCLUDING FLAP
ENTRY AND CLOSURE
D6103 1/1/2013 D M
BONE GRAFT FOR REPAIR OF PERI-IMPLANT DEFECT -
DOES NOT INCLUDE FLAP ENTRY AND CLOSURE
D6104 1/1/2013 D M BONE GRAFT AT TIME OF IMPLANT PLACEMENT
D6110 1/1/2015 D M
IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE
FOR EDENTULOUS ARCH - MAXILLARY
D6111 1/1/2015 D M
IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE
FOR EDENTULOUS ARCH - MANDIBULAR
D6112 1/1/2015 D M
IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE
FOR PARTIALLY EDENTULOUS ARCH - MAXILLARY
D6113 1/1/2015 D M
IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE
FOR PARTIALLY EDENTULOUS ARCH - MANDIBULAR
D6114 1/1/2015 D M
IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR
EDENTULOUS ARCH - MAXILLARY
D6115 1/1/2015 D M
IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR
EDENTULOUS ARCH - MANDIBULAR
D6116 1/1/2015 D M
IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR
PARTIALLY EDENTULOUS ARCH - MAXILLARY
D6117 1/1/2015 D M
IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR
PARTIALLY EDENTULOUS ARCH - MANDIBULAR
D6118 1/1/2018 D M
IMPLANT/ABUTMENT SUPPORTED INTERIM FIXED
DENTURE FOR EDENTULOUS ARCH - MANDIBULAR
D6119 1/1/2018 D M
IMPLANT/ABUTMENT SUPPORTED INTERIM FIXED
DENTURE FOR EDENTULOUS ARCH - MAXILLARY
D6120 1/1/2020 D M
IMPLANT SUPPORTED RETAINER - PORCELAIN FUSED TO
TITANIUM AND TITANIUM ALLOYS
D6121 1/1/2020 D M
IMPLANT SUPPORTED RETAINER FOR METAL FPD -
PREDOMINANTLY BASE ALLOYS
D6122 1/1/2020 D M
IMPLANT SUPPORTED RETAINER FOR METAL FPD -
NOBLE ALLOYS
D6123 1/1/2020 D M
IMPLANT SUPPORTED RETAINER FOR METAL FPD -
TITANIUM AND TITANIUM ALLOYS
D6190 1/1/2005 D M RADIOGRAPHIC/SURGICAL IMPLANT INDEX, BY REPORT
D6194 1/1/2005 D M
ABUTMENT SUPPORTED RETAINER CROWN FOR FPD -
TITANIUM AND TITANIUM ALLOYS
D6195 1/1/2020 D M
ABUTMENT SUPPORTED RETAINER - PORCELAIN FUSED
TO TITANIUM AND TITANIUM ALLOYS
D6199 1/1/1992 D M UNSPECIFIED IMPLANT PROCEDURE, BY REPORT
D6205 1/1/2005 D M PONTIC - INDIRECT RESIN BASED COMPOSITE
D6210 1/1/1985 D M PONTIC - CAST HIGH NOBLE METAL
D6211 1/1/1985 D M PONTIC - CAST PREDOMINATLY BASE METAL
D6212 1/1/1985 D M PONTIC - CAST NOBLE METAL
D6214 1/1/2005 D M PONTIC - TITANIUM AND TITANIUM ALLOYS
D6240 1/1/1985 D M PONTIC - PORCELAIN FUSED TO HIGH NOBLE METAL
D6241 1/1/1985 D M
PONTIC - PORCELAIN FUSED TO PREDOMINANTLY BASE
METAL
D6242 1/1/1985 D M PONTIC - PORCELAIN FUSED TO NOBLE METAL
D6243 1/1/2020 D M
PONTIC - PORCELAIN FUSED TO TITANIUM AND TITANIUM
ALLOYS
D6245 1/1/2000 D M PONTIC - PROCELAIN/CERAMIC
D6250 1/1/1985 D M PONTIC - RESIN WITH HIGH NOBLE METAL
D6251 1/1/1985 D M PONTIC - RESIN WITH PREDOMINANTLY BASE METAL
D6252 1/1/1985 D M PONTIC - RESIN WITH NOBLE METAL
D6253 1/1/2003 D M
PROVISIONAL PONTIC- FURTHER TREATMENT OR
COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO
FINAL IMPRESSION
D6545 1/1/1985 D M
RETAINER - CAST METAL FOR RESIN BONDED FIXED
PROSTHESIS
D6548 1/1/2000 D M
RETAINER - PORCELAIN/CERAMIC FOR RESIN BONDED
FIXED PROSTHESIS
D6549 1/1/2015 D M
RESIN RETAINER - FOR RESIN BONDED FIXED
PROSTHESIS
D6600 1/1/2003 D M
RETAINER INLAY - PORCELAIN/CERAMIC, TWO
SURFACES
D6601 1/1/2003 D M
RETAINER INLAY - PORCELAIN/CERAMIC, THREE OR
MORE SURFACES
D6602 1/1/2003 D M
RETAINER INLAY - CAST HIGH NOBLE METAL, TWO
SURFACES
D6603 1/1/2003 D M
RETAINER INLAY - CAST HIGH NOBLE METAL, THREE OR
MORE SURFACES
D6604 1/1/2003 D M
RETAINER INLAY - CAST PREDOMINANTLY BASE METAL,
TWO SURFACES
D6605 1/1/2003 D M
RETAINER INLAY - CAST PREDOMINANTLY BASE METAL,
THREE OR MORE SURFACES
D6606 1/1/2003 D M RETAINER INLAY - CAST NOBLE METAL, TWO SURFACES
D6607 1/1/2003 D M
RETAINER INLAY - CAST NOBLE METAL, THREE OR MORE
SURFACES
D6608 1/1/2003 D M
RETAINER ONLAY - PORCELAIN/CERAMIC, TWO
SURFACES
D6609 1/1/2003 D M
RETAINER ONLAY - PORCELAIN/CERAMIC, THREE OR
MORE SURFACES
D6610 1/1/2003 D M
RETAINER ONLAY - CAST HIGH NOBLE METAL, TWO
SURFACES
D6611 1/1/2003 D M
RETAINER ONLAY - CAST HIGH NOBLE METAL, THREE OR
MORE SURFACES
D6612 1/1/2003 D M
RETAINER ONLAY - CAST PREDOMINANTLY BASE METAL,
TWO SURFACES
D6613 1/1/2003 D M
RETAINER ONLAY - CAST PREDOMINANTLY BASE METAL,
THREE OR MORE SURFACES
D6614 1/1/2003 D M RETAINER ONLAY - CAST NOBLE METAL, TWO SURFACES
D6615 1/1/2003 D M
RETAINER ONLAY - CAST NOBLE METAL, THREE OR
MORE SURFACES
D6624 1/1/2005 D M RETAINER INLAY - TITANIUM
D6634 1/1/2005 D M RETAINER ONLAY - TITANIUM
D6710 1/1/2005 D M RETAINER CROWN - INDIRECT RESIN BASED COMPOSITE
D6720 1/1/1985 D M RETAINER CROWN - RESIN WITH HIGH NOBLE METAL
D6721 1/1/1986 D M
RETAINER CROWN - RESIN WITH PREDOMINANTLY BASE
METAL
D6722 1/1/1985 D M RETAINER CROWN - RESIN WITH NOBLE METAL
D6740 1/1/2000 D M RETAINER CROWN - PORCELAIN/CERAMIC
D6750 1/1/1985 D M
RETAINER CROWN - PORCELAIN FUSED TO HIGH NOBLE
METAL
D6751 1/1/1985 D M
RETAINER CROWN - PORCELAIN FUSED TO
PREDOMINANTLY BASE METAL
D6752 1/1/1985 D M
RETAINER CROWN - PORCELAIN FUSED TO NOBLE
METAL
D6753 1/1/2020 D M
RETAINER CROWN - PORCELAIN FUSED TO TITANIUM
AND TITANIUM ALLOYS
D6780 1/1/1985 D M RETAINER CROWN -3/4 CAST HIGH NOBLE METAL
D6781 1/1/2000 D M
RETAINER CROWN - 3/4 CAST PREDOMINANTLY BASE
METAL
D6782 1/1/2000 D M RETAINER CROWN - 3/4 CAST NOBLE METAL
D6783 1/1/2000 D M RETAINER CROWN - 3/4 PORCELAIN/CERAMIC
D6784 1/1/2020 D M RETAINER CROWN 3/4 - TITANIUM AND TITANIUM ALLOYS
D6790 1/1/1985 D M RETAINER CROWN - FULL CAST HIGH NOBLE METAL
D6791 1/1/1985 D M
RETAINER CROWN - FULL CAST PREDOMINANTLY BASE
METAL
D6792 1/1/1985 D M RETAINER CROWN - FULL CAST NOBLE METAL
D6793 1/1/2003 D M
PROVISIONAL RETAINER CROWN- FURTHER TREATMENT
OR COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO
FINAL IMPRESSION
D6794 1/1/2005 D M RETAINER CROWN - TITANIUM AND TITANIUM ALLOYS
D6920 1/1/1996 D M CONNECTOR BAR
D6930 1/1/1985 D M RE-CEMENT OR RE-BOND FIXED PARTIAL DENTURE
D6940 1/1/1985 D M STRESS BREAKER
D6950 1/1/1985 D M PRECISION ATTACHMENT
D6980 1/1/1986 D M
FIXED PARTIAL DENTURE REPAIR NECESSITATED BY
RESTORATIVE MATERIAL FAILURE
D6985 1/1/2003 D M PEDIATRIC PARTIAL DENTURE, FIXED
D6999 1/1/1985 D M
UNSPECIFIED FIXED PROSTHODONTIC PROCEDURE, BY
REPORT
D7140 1/1/2003 D M EXTRACTION, CORONAL REMNANTS - PRIMARY TOOTH
D7210 1/1/1985 D M
EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT
(ELEVATION AND/OR FORCEPS REMOVAL)
D7220 1/1/1985 D M REMOVAL OF IMPACTED TOOTH - SOFT TISSUE
D7230 1/1/1985 D M REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY
D7240 1/1/1985 D M REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY
D7241 1/1/1985 D M
REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY,
WITH UNUSUAL SURGICAL COMPLICATIONS
D7250 1/1/1985 D M
REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING
PROCEDURE)
D7251 1/1/2011 D M
CORONECTOMY - INTENTIONAL PARTIAL TOOTH
REMOVAL
D7270 1/1/1985 D M
TOOTH REIMPLANTATION AND/OR STABILIZATION OF
ACCIDENTALLY EVULSED OR DISPLACED TOOTH
D7272 1/1/1985 D M
TOOTH TRANSPLANTATION (INCLUDES REIMPLANTATION
FROM ONE SITE TO ANOTHER AND SPLINTING AND/OR
STABILIZATION)
D7280 1/1/1985 D M EXPOSURE OF AN UNERUPTED TOOTH
D7282 1/1/2003 D M
MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH
TO AID ERUPTION
D7283 1/1/2005 D M
PLACEMENT OF AN ATTACHMENT ON AN UNERUPTED
TOOTH, AGTER ITS EXPOSURE, TO AID IN ITS ERUPTION.
REPORT THE SURGICAL EXPOSURE SEPERATELY USING
D7280.
D7291 1/1/1986 D M
TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL
FIBEROTOMY, BY REPORT
D7310 1/1/1985 D M
ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS -
FOUR OR MORE TEETH OR TOOTH SPACES, PER
QUADRANT
D7311 1/1/2005 D M
ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS -
ONE TO THREE TEETH OR TOOTH SPACES, PER
QUANDRANT
D7320 1/1/1985 D M
ALVEOLOPLASTY NOT IN CONJUNCTION WITH
EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH
SPACES, PER QUADRANT
D7321 1/1/2005 D M
ALVEOLOPLASTY NOT IN CONJUNCTION WITH
EXTRACTIONS - ONE TO THREE TEETH OR TOOTH
SPACES, PER QUADRANT
D7340 1/1/1985 D M
VESTIBULOPLASTY - RIDGE EXTENSION (SECONDARY
EPITHELIALIZATION)
D7350 1/1/1985 D M
VESTIBULOPLASTY - RIDGE EXTENSION (INCLUDING
SOFT TISSUE GRAFTS, MUSCLE REATTACHMENT,
REVISION OF SOFT TISSUE ATTACHMENT AND
MANAGEMENT OF HYPERTROPHIED AND HYPERPLASTIC
TISSUE)
D7510 1/1/1985 D M
INCISION AND DRAINAGE OF ABSCESS - INTRAORAL
SOFT TISSUE
D7511 1/1/2005 D M
INCISION AND DRAINAGE OF ABSCESS - INTRAORAL
SOFT TISSUE - COMPLICATED (INCLUDES DRAINAGE OF
MULTIPLE FASCIAL SPACES)
D7810 1/1/1985 D M OPEN REDUCTION OF DISLOCATION
D7820 1/1/1985 D M CLOSED REDUCTION OF DISLOCATION
D7830 1/1/1985 D M MANIPULATION UNDER ANESTHESIA
D7840 1/1/1985 D M CONDYLECTOMY
D7850 1/1/1985 D M SURGICAL DISCECTOMY, WITH/WITHOUT IMPLANT
D7852 1/1/1992 D M DISC REPAIR
D7854 1/1/1992 D M SYNOVECTOMY
D7856 1/1/1992 D M MYOTOMY
D7858 1/1/1992 D M JOINT RECONSTRUCTION
D7860 1/1/1985 D M ARTHROTOMY
D7865 1/1/1992 D M ARTHROPLASTY
D7870 1/1/1985 D M ARTHROCENTESIS
D7871 1/1/2000 D M NON-ARTHROSCOPIC LYSIS AND LAVAGE
D7872 1/1/1992 D M
ARTHROSCOPY - DIAGNOSTIC, WITH OR WITHOUT
BIOPSY
D7873 1/1/1992 D M ARTHROSCOPY: LAVAGE AND LYSIS OF ADHESIONS
D7874 1/1/1992 D M
ARTHROSCOPY: DISC REPOSITIONING AND
STABILIZATION
D7875 1/1/1992 D M ARTHROSCOPY: SYNOVECTOMY
D7876 1/1/1992 D M ARTHROSCOPY: DISCECTOMY
D7877 1/1/1992 D M ARTHROSCOPY: DEBRIDEMENT
D7880 1/1/1986 D M OCCLUSAL ORTHOTIC DEVICE, BY REPORT
D7881 1/1/2016 D M OCCLUSAL ORTHOTIC DEVICE ADJUSTMENT
D7899 1/1/1992 D M UNSPECIFIED TMD THERAPY, BY REPORT
D7922 1/1/2020 D M
PLACEMENT OF INTRA-SOCKET BIOLOGICAL DRESSING
TO AID IN HEMOSTASIS OR CLOT STABILIZATION, PER
SITE
D7944 1/1/1985 D M OSTEOTOMY - SEGMENTED OR SUBAPICAL
D7945 1/1/1985 D M OSTEOTOMY - BODY OF MANDIBLE
D7946 1/1/1985 D M LEFORT I (MAXILLA - TOTAL)
D7947 1/1/1985 D M LEFORT I (MAXILLA - SEGMENTED)
D7948 1/1/1985 D M
LEFORT II OR LEFORT III (OSTEOPLASTY OF FACIAL
BONE FOR MIDFACE HYPOPLASIA OR RETRUSION) -
WITHOUT BONE GRAFT
D7950 1/1/1985 D M
OSSEOUS, OSTEOPERIOSTEAL, OR CARTILAGE GRAFT
OF THE MANDIBLE OR MAXILLA - AUTOGENOUS OR
NONAUTOGENOUS, BY REPORT
D7960 1/1/1985 D M
FRENULECTOMY - ALSO KNOWN AS FRENECTOMY OR
FRENOTOMY - SEPARATE PROCEDURE NOT INCIDENTAL
TO ANOTHER PROCEDURE
D7963 1/1/2005 D M FRENULOPLASTY
D7971 1/1/1986 D M EXCISION OF PERICORONAL GINGIVAL
D7995 1/1/1996 D M
SYNTHETIC GRAFT - MANDIBLE OR FACIAL BONES, BY
REPORT
D7997 1/1/2000 D M
APPLIANCE REMOVAL (NOT BY DENTIST WHO PLACED
APPLIANCE), INCLUDES REMOVAL OF ARCHBAR
D7998 1/1/2007 D M
INTRAORAL PLACEMENT OF A FIXATION DEVICE NOT IN
CONJUNCTION WITH A FRACTURE
D7999 1/1/1985 D M UNSPECIFIED ORAL SURGICAL PROCEDURE, BY REPORT
D8000 1/1/1987 D M INITIAL PAYMENT
D8010 1/1/1996 D M
LIMITED ORTHODONTIC TREATMENT OF THE PRIMARY
DENTITION
D8020 1/1/1996 D M
LIMITED ORTHODONTIC TREATMENT OF THE
TRANSITIONAL DENTITION
D8030 1/1/1996 D M
LIMITED ORTHODONTIC TREATMENT OF THE
ADOLESCENT DENTITION
D8040 1/1/1996 D M
LIMITED ORTHODONTIC TREATMENT OF THE ADULT
DENTITION
D8050 1/1/1996 D M
INTERCEPTIVE ORTHODONTIC TREATMENT OF THE
PRIMARY DENTITION
D8060 1/1/1996 D M
INTERCEPTIVE ORTHODONTIC TREATMENT OF THE
TRANSITIONAL DENTITION
D8070 1/1/1996 D M
COMPREHENSIVE ORTHODONTIC TREATMENT OF THE
TRANSITIONAL DENTITION
D8080 1/1/1996 D M
COMPREHENSIVE ORTHODONTIC TREATMENT OF THE
ADOLESCENT DENTITION
D8090 1/1/1996 D M
COMPREHENSIVE ORTHODONTIC TREATMENT OF THE
ADULT DENTITION
D8099 1/1/1987 D M
ORTHODONTIC RETENTION (REMOVAL OF APPLIANCE,
CONSTRUCTION AND PLACEMENT OF RETAINER(S))
D8210 1/1/1985 D M REMOVABLE APPLIANCE THERAPY
D8220 1/1/1985 D M FIXED APPLIANCE THERAPY
D8660 1/1/1996 D M
PRE-ORTHODONTIC TREATMENT EXAMINATION TO
MONITOR GROWTH AND DEVELOPMENT
D8670 1/1/1996 D M PERIODIC ORTHODONTIC TREATMENT VISIT
D8680 1/1/1996 D M
ORTHODONTIC RETENTION (REMOVAL OF APPLIANCES,
CONSTRUCTION AND PLACEMENT OF RETAINER(S))
D8681 1/1/2016 D M REMOVABLE ORTHODONTIC RETAINER ADJUSTMENT
D8690 1/1/1996 D M
ORTHODONTIC TREATMENT, (ALTERNATIVE BILLING TO A
CONTRACT FEE)
D8695 1/1/2018 D M
REMOVAL OF FIXED ORTHODONTIC APPLIANCES FOR
REASONS OTHER THAN COMPLETION OF TREATMENT
D8696 1/1/2020 D M REPAIR OF ORTHODONTIC APPLIANCE - MAXILLARY
D8697 1/1/2020 D M REPAIR OF ORTHODONTIC APPLIANCE - MANDIBULAR
D8698 1/1/2020 D M RE-CEMENT OR RE-BOND FIXED RETAINER - MAXILLARY
D8699 1/1/2020 D M
RE-CEMENT OR RE-BOND FIXED RETAINER -
MANDIBULAR
D8701 1/1/2020 D M
REPAIR OF FIXED RETAINER, INCLUDES REATTACHMENT -
MAXILLARY
D8702 1/1/2020 D M
REPAIR OF FIXED RETAINER, INCLUDES REATTACHMENT -
MANDIBULAR
D8703 1/1/2020 D M
REPLACEMENT OF LOST OR BROKEN RETAINER -
MAXILLARY
D8704 1/1/2020 D M
REPLACEMENT OF LOST OR BROKEN RETAINER -
MANDIBULAR
D8999 1/1/1985 D M UNSPECIFIED ORTHODONTIC PROCEDURE, BY REPORT
D9110 1/1/1985 D M
PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN -
MINOR PROCEDURES
D9120 1/1/2007 D M FIXED PARTIAL DENTURE SECTIONING
D9210 1/1/1985 D M
LOCAL ANESTHESIA NOT IN CONJUNCTION WITH
OPERATIVE OR SURGICAL PROCEDURES
D9211 1/1/1985 D M REGIONAL BLOCK ANESTHESIA
D9212 1/1/1985 D M TRIGEMINAL DIVISION BLOCK ANESTHESIA
D9215 1/1/1985 D M
LOCAL ANESTHESIA IN CONJUNCTION WITH OPERATIVE
OR SURGICAL PROCEDURES
D9219 1/1/2015 D M
EVALUATION FOR MODERATE SEDATION, DEEP
SEDATION OR GENERAL ANESTHESIA
D9222 1/1/2018 D M
DEEP SEDATION/GENERAL ANESTHESIA - FIRST 15
MINUTES
D9223 1/1/2016 D M
DEEP SEDATION/GENERAL ANESTHESIA - EACH
SUBSEQUENT 15 MINUTE INCREMENT
D9230 1/1/1985 D M INHALATION OF NITROUS OXIDE/ANXIOLYSIS, ANALGESIA
D9239 1/1/2018 D M
INTRAVENOUS MODERATE (CONSCIOUS)
SEDATION/ANALGESIA- FIRST 15 MINUTES
D9243 1/1/2016 D M
INTRAVENOUS MODERATE (CONSCIOUS)
SEDATION/ANALGESIA - EACH SUBSEQUENT 15 MINUTE
INCREMENT
D9248 1/1/2000 D M NON-INTRAVENOUS CONSCIOUS SEDATION
D9310 1/1/1985 D M
CONSULTATION - DIAGNOSTIC SERVICE PROVIDED BY
DENTIST OR PHYSICIAN OTHER THAN REQUESTING
DENTIST OR PHYSICIAN
D9311 1/1/2017 D M
CONSULTATION WITH A MEDICAL HEALTH CARE
PROFESSIONAL
D9410 1/1/1985 D M HOUSE/EXTENDED CARE FACILITY CALL
D9420 1/1/1985 D M HOSPITAL OR AMBULATORY SURGICAL CENTER CALL
D9430 1/1/1985 D M
OFFICE VISIT FOR OBSERVATION (DURING REGULARLY
SCHEDULED HOURS) - NO OTHER SERVICES
PERFORMED
D9440 1/1/1985 D M OFFICE VISIT - AFTER REGULARLY SCHEDULED HOURS
D9450 1/1/2003 D M
CASE PRESENTATION, DETAILED AND EXTENSIVE
TREATMENT PLANNING
D9610 1/1/1985 D M
THERAPEUTIC PARENTERAL DRUG, SINGLE
ADMINISTRATION
D9612 1/1/2007 D M
THERAPEUTIC PARENTERAL DRUGS, TWO OR MORE
ADMINISTRATIONS, DIFFERENT MEDICATIONS
D9613 1/1/2019 D M
INFILTRATION OF SUSTAINED RELEASE THERAPEUTIC
DRUG- SINGLE OR MULTIPLE SITES
D9630 1/1/1985 D M
DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE
FOR HOME USE
D9910 1/1/1985 D M APPLICATION OF DESENSITIZING MEDICAMENT
D9911 1/1/2000 D M
APPLICATION OF DESENSITIZING RESIN FOR CERVICAL
AND/OR ROOT SURFACE, PER TOOTH
D9920 1/1/1986 D M BEHAVIOR MANAGEMENT, BY REPORT
D9930 1/1/1985 D M
TREATMENT OF COMPLICATIONS (POST-SURGICAL) -
UNUSUAL CIRCUMSTANCES, BY REPORT
D9932 1/1/2016 D M
CLEANING AND INSPECTION OF REMOVABLE COMPLETE
DENTURE, MAXILLARY
D9933 1/1/2016 D M
CLEANING AND INSPECTION OF REMOVABLE COMPLETE
DENTURE, MANDIBULAR
D9934 1/1/2016 D M
CLEANING AND INSPECTION OF REMOVABLE PARTIAL
DENTURE, MAXILLARY
D9935 1/1/2016 D M
CLEANING AND INSPECTION OF REMOVABLE PARTIAL
DENTURE, MANDIBULAR
D9941 1/1/1986 D M FABRICATION OF ATHLETIC MOUTHGUARD
D9942 1/1/2005 D M REPAIR AND/OR RELINE OF OCCLUSAL GUARD
D9943 1/1/2016 D M OCCLUSAL GUARD ADJUSTMENT
D9944 1/1/2019 D M OCCLUSAL GUARD - HARD APPLIANCE, FULL ARCH
D9945 1/1/2019 D M OCCLUSAL GUARD - SOFT APPLIANCE, FULL ARCH
D9946 1/1/2019 D M OCCLUSAL GUARD- HARD APPLIANCE, PARTIAL ARCH
D9950 1/1/1985 D M OCCLUSION ANALYSIS - MOUNTED CASE
D9951 1/1/1986 D M OCCLUSAL ADJUSTMENT - LIMITED
D9952 1/1/1986 D M OCCLUSAL ADJUSTMENT - COMPLETE
D9970 1/1/1996 D M ENAMEL MICROABRASION
D9971 1/1/2000 D M
ODONTOPLASTY 1-2 TEETH; INCLUDES REMOVAL OF
ENAMEL PROJECTIONS
D9972 1/1/2000 D M
EXTERNAL BLEACHING - PER ARCH - PERFORMED IN
OFFICE
D9973 1/1/2000 D M EXTERNAL BLEACHING - PER TOOTH
D9974 1/1/2000 D M INTERNAL BLEACHING - PER TOOTH
D9975 1/1/2013 D M
EXTERNAL BLEACHING FOR HOME APPLICATION, PER
ARCH; INCLUDES MATERIALS AND FABRICATION OF
CUSTOM TRAYS
D9985 1/1/2014 D M SALES TAX
D9986 1/1/2015 D M MISSED APPOINTMENT
D9987 1/1/2015 D M CANCELLED APPOINTMENT
D9991 1/1/2017 D M
DENTAL CASE MANAGEMENT ADDRESSING
APPOINTMENT COMPLIANCE BARRIERS
D9992 1/1/2017 D M DENTAL CASE MANAGEMENT CARE COORDINATION
D9993 1/1/2017 D M
DENTAL CASE MANAGEMENT MOTIVATIONAL
INTERVIEWING
D9994 1/1/2017 D M
DENTAL CASE MANAGEMENT PATIENT EDUCATION TO
IMPROVE ORAL HEALTH LITERACY
D9995 1/1/2018 D M
TELEDENTISTRY - SYNCHRONOUS; REAL-TIME
ENCOUNTER
D9996 1/1/2018 D M
TELEDENTISTRY - ASYNCHRONOUS; INFORMATION
STORED AND FORWARDED TO DENTIST FOR
SUBSEQUENT REVIEW
D9997 1/1/2020 D
DENTAL CASE MANAGEMENT - PATIENTS WITH SPECIAL
HEALTH CARE NEEDS
D9999 1/1/1985 D M UNSPECIFIED ADJUNCTIVE PROCEDURE, BY REPORT
X0005 1/1/1987 D
ANCILLARY DENTAL SERVICE (PRI BUS ONLY - INTERNAL
USE)
X0006 1/1/1987 D
INELIGIBLE DENTAL SERVICE (PRI BUS - INTERNAL USE
ONLY)
X0008 1/1/2016 D
ANCILLARY DENTAL SERVICE (PACHIP FQHC INTERNAL
USE)
XD001 1/1/2014 D
VISION SERVICE ACCUMULATOR - FOR INTERNAL USE
ONLY
XD002 1/1/2014 D RX SERVICE ACCUMULATOR - FOR INTERNAL USE ONLY
XD003 1/1/2014 D
MED SURG SERVICE ACCUMULATOR - FOR INTERNAL
USE ONLY