7 Colo. Code Regs. § 1101-3 R18 Exhibits, exh. #3
Proc | Description | Rate |
D0120 | PERIODIC ORAL EVALUATION - EST PATIENT | 80.59 |
D0140 | LIMITED ORAL EVALUATION - PROBLEM FOCUSED | 135.11 |
D0145 | ORAL EVAL PT UND 3 YR AGE CNSL W/PRIM CAREGIVER | 125.63 |
D0150 | COMP ORAL EVALUATION - NEW OR EST PATIENT | 142.23 |
D0160 | DTL&EXT ORAL EVALUATION - PROBLEM FOCUSED REPORT | 284.45 |
D0170 | RE-EVALUATION - LIMITED PROBLEM FOCUSED | 94.82 |
D0171 | RE-EVALUATION POST-OPERATIVE OFFICE VISIT | 94.82 |
D0180 | COMP PERIODONTAL EVALUATION - NEW OR EST PATIENT | 154.08 |
D0190 | SCREENING OF A PATIENT | 80.59 |
D0191 | ASSESSMENT OF A PATIENT | 56.89 |
D0210 | INTRAORAL COMPREHENSIVE SERIES RADIOGPHIC IMAGES | 213.65 |
D0220 | INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE | 42.73 |
D0230 | INTRAORAL-PERIAPICAL-EACH ADDITIONAL IMAGE | 38.46 |
D0240 | INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE | 66.23 |
D0250 | EXTRAORAL 2D PRJECTN RAD IMG BY RAD SRCE/ DTECTR | 81.19 |
D0251 | EXTRAORAL POSTERIOR DENTAL RAD IMAGE | 74.78 |
D0270 | BITEWING - SINGLE RADIOGRAPHIC IMAGE | 42.53 |
D0272 | BITEWINGS - TWO RADIOGRAPHIC IMAGES | 68.04 |
D0273 | BITEWINGS - THREE RADIOGRAPHIC IMAGES | 82.92 |
D0274 | BITEWINGS - FOUR RADIOGRAPHIC IMAGES | 95.68 |
D0277 | VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES | 144.59 |
D0310 | SIALOGRAPHY | 561.28 |
D0320 | TEMPOROMANDIBULAR JOINT ARTHROGRAM INCL INJ | 991.59 |
D0321 | OTHER TEMPOROMANDIBULAR JOINT IMAGES BY REPORT | 0.00 |
D0322 | TOMOGRAPHIC SURVEY | 804.50 |
D0330 | PANORAMIC RADIOGRAPHIC IMAGE | 174.00 |
D0340 | 2D CEPHLOMTRIC RAD IMG - ACQSTN MEASRE& ANALYSIS | 196.45 |
D0350 | 2D ORAL/FACIAL PHOTOGRAPHIC IMAGES | 93.55 |
D0351 | 3D PHOTOGRAPHIC IMAGE | 93.55 |
D0364 | CNE BEAM CAPTR & INTREP LESS THAN WHL JAW | 312.44 |
D0365 | CNE BEAM CAPTR INTERP W FLD VIEW 1 ARCH MNDBL | 398.51 |
D0366 | CNE BEAM CAPTR INTERP W FLD VIEW 1 ARCH MAXL | 398.51 |
D0367 | CNE BEAM CAPTR INTERP W FLD VIEW BTH JAWS | 449.02 |
D0368 | CNE BEAM CAPTR INTERP FR TMJ 2 OR MORE | 462.12 |
D0369 | MAXILLOFACIAL MRI CAPTURE AND INTERPRETATION | 261.93 |
D0370 | MAXLFCL US IMAGE CAPTR AND INTRP | 149.67 |
D0371 | SIALOENDOSCOPY CAPTURE AND INTERPRETATION | 0.00 |
D0372 | INTRAORAL TOMOSYNTHESIS COMPLETE SERIES RAD IMGS | 0.00 |
D0373 | INTRAORAL TOMOSYNTHESIS BITEWING RADIOG IMAGE | 0.00 |
D0374 | INTRAORAL TOMOSYNTHESIS PERIAPICAL RADIOG IMAGE | 0.00 |
D0380 | CNE BEAM CAPTR LMTD FLD <1 WHL JAW | 321.80 |
D0381 | CNE BEAM CAPTR W FLD VIEW 1 ARCH MNDBL | 435.92 |
D0382 | CNE BEAM CAPTR W FLD VIEW 1 ARCH MAXL | 435.92 |
D0383 | CNE BEAM CAPTR W FLD VIEW BTH JAWS | 435.92 |
D0384 | CNE BEAM CAPTR FR TMJ 2 OR MORE | 467.73 |
D0385 | MAXILLOFACIAL MRI IMAGE CAPTURE | 2871.86 |
D0386 | MAXILLOFACIAL ULTRASOUND IMAGE CAPTURE | 718.43 |
D0387 | INTRAORAL TOMOSYNTHESIS CMPL SERIES RAD IMG CAPT | 0.00 |
D0388 | INTRAORAL TOMOSYNTHESIS BITEWING RAD IMAGE CAPTR | 0.00 |
D0389 | INTRAORAL TOMOSYNTHESIS PERIAPICAL RAD IMGE CAPT | 0.00 |
D0391 | INTERPRETATION OF DIAGNOSTIC IMAGE | 0.00 |
D0393 | VIRTL TREMNT SIM USING 3D IMG VOL OR SURF SCAN | 0.00 |
D0394 | DIGITAL SUBTR OF 2 > IMAGES OF THE SAME MODALITY | 0.00 |
D0395 | FUSION OF 2/> 3D IMAGE VOLUMES OF 1/> MODALITIES | 0.00 |
D0396 | 3D PRINTING OF A 3D DENTAL SURFACE SCAN | 0.00 |
D0411 | HBA1C IN-OFFICE POINT OF SERVICE TESTING | 0.00 |
D0412 | BLOOD GLCSE LVL TST - IN-OFFICE USING GLCSE MTR | 0.00 |
D0414 | LAB MICRBAL SPEC CULTRE/SENS/REPORT PREP TRNSMSN | 70.20 |
D0415 | COLLECTION MICROORGANISMS CULTURE & SENSITIVITY | 50.90 |
D0416 | VIRAL CULTURE | 75.47 |
D0417 | CLCT & PREP SALIVA SAMPLE FOR LAB DX TESTING | 68.45 |
D0418 | ANALYSIS OF SALIVA SAMPLE | 70.20 |
D0419 | ASSESSMENT OF SALIVARY FLOW BY MEASUREMENT | 0.00 |
D0422 | COLLECT/PREP GENETIC SAMPLE FOR LAB ANALYSIS | 50.90 |
D0423 | GENETIC TEST SUSCEPT TO DSEASE SPECIMEN ANLYS | 0.00 |
D0425 | CARIES SUSCEPTIBILITY TESTS | 43.88 |
D0431 | ADJUNCTIVE PREDX TST NOT INCL CYTOLOGY/BX PROC | 70.20 |
D0460 | PULP VITALITY TESTS | 70.20 |
D0470 | DIAGNOSTIC CASTS | 154.44 |
D0472 | ACCESSION OF TISSUE GROSS EXAMINATION PREP/REPRT | 96.53 |
D0473 | ACCESS TISSUE GR&MIC EXAMINATION PREP/REPRT | 203.58 |
D0474 | ACCESS TISS GR&MIC EX ASSESS SURG MARG PREP/RPT | 228.15 |
D0475 | DECALCIFICATION PROCEDURE | 122.85 |
D0476 | SPECIAL STAINS FOR MICROORGANISMS | 119.34 |
D0477 | SPECIAL STAINS NOT FOR MICROORGANISMS | 163.22 |
D0478 | IMMUNOHISTOCHEMICAL STAINS | 149.18 |
D0479 | TISSUE INSITU HYBRIDIZATION INCL INTERPRETATION | 228.15 |
D0480 | ACESS EXFOLIATIVE CYTOL SMEAR MIC EXAM PREP/REPT | 140.40 |
D0481 | ELECTRON MICROSCOPY | 526.50 |
D0482 | DIRECT IMMUNOFLUORESCENCE | 175.50 |
D0483 | INDIRECT IMMUNOFLUORESCENCE | 175.50 |
D0484 | CONSULTATION ON SLIDES PREPARED ELSEWHERE | 263.25 |
D0485 | CONSULT INCL PREP SLIDES BX MATL SPL REF SRC | 363.29 |
D0486 | ACCESSION TRANSEPITHELIAL CYTOLOG SAMPL MIC EXAM | 168.48 |
D0502 | OTHER ORAL PATHOLOGY PROCEDURES BY REPORT | 0.00 |
D0600 | DX PX QUANT/MNITR/RECRD CHNGS ENAML/DENTN/CEMNTM | 0.00 |
D0601 | CARIES RISK ASSESS DOCU FINDING OF LOW RISK | 17.67 |
D0602 | CARIES RISK AX AND DOCU WITH A FNDNG OF MOD RISK | 17.67 |
D0603 | CARIES RISK AX AND DOCU WITH FNDNG OF HIGH RISK | 17.67 |
D0604 | ANTIGEN TEST PUB HLTH PATHOGEN INCL CORONAVIRUS | 11.49 |
D0605 | ANTIBODY TEST PUB HLTH PATHOGEN INCL CORONAVIRUS | 8.54 |
D0606 | MOLECULAR TEST PUB HEALTH PATHOGEN-CORONAVIRUS | 0.00 |
D0701 | PANORAMIC FILM - IMAGE CAPTURE ONLY | 174.00 |
D0702 | 2-D CEPHALOMETRIC FILM - IMAGE CAPTURE ONLY | 196.45 |
D0703 | 2-D ORAL/FACIAL FILM - IMAGE CAPTURE ONLY | 93.55 |
D0704 | 3-D PHOTOGRAPHIC FILM - IMAGE CAPTURE ONLY | 93.55 |
D0705 | EXTRA-ORAL POSTERIOR FLM - IMAGE CAPTURE ONLY | 74.78 |
D0706 | INTRAORAL OCCLUSAL FILM - IMAGE CAPTURE ONLY | 66.23 |
D0707 | INTRAORAL PERIAPICAL FLM - IMAGE CAPTURE ONLY | 42.73 |
D0708 | INTRAORAL BITEWING - IMAGE CAPTURE ONLY | 42.53 |
D0709 | INTRAORAL CMPRHNSV SERIES RAD IMAGE CAPT ONLY | 213.65 |
D0801 | 3D DENTAL SURFACE SCAN DIRECT | 0.00 |
D0802 | 3D DENTAL SURFACE SCAN INDIRECT | 0.00 |
D0803 | 3D FACIAL SURFACE SCAN DIRECT | 0.00 |
D0804 | 3D FACIAL SURFACE SCAN INDIRECT | 0.00 |
D0999 | UNSPECIFIED DIAGNOSTIC PROCEDURE BY REPORT | 0.00 |
D1110 | PROPHYLAXIS - ADULT | 140.06 |
D1120 | PROPHYLAXIS - CHILD | 96.66 |
D1206 | TOPICAL APPLICATION OF FLUORIDE VARNISH | 67.18 |
D1208 | TOPICAL APPLICATION OF FLUORIDE EXCL VARNISH | 44.79 |
D1301 | IMMUNIZATION COUNSELING | 0.00 |
D1310 | NUTRITIONAL COUNSELING CONTROL OF DENTAL DISEASE | 72.07 |
D1320 | TOBACCO CNSL CONTROL & PREVENTION ORAL DISEASE | 78.25 |
D1321 | COUNSEL ADVRSE EFFECTS HI RISK SUBSTNCE ABUSE | 98.84 |
D1330 | ORAL HYGIENE INSTRUCTIONS | 98.84 |
D1351 | SEALANT - PER TOOTH | 80.31 |
D1352 | PREV RSN REST MOD HIGH CARIES RISK PT-PERM TOOTH | 102.96 |
D1353 | SEALANT REPAIR PER TOOTH | 102.96 |
D1354 | INTERIM CARIES ARRESTING MEDICATION APPLICATION | 80.31 |
D1355 | CARIES PREVENTIVE MEDICAMENT APP - PER TOOTH | 80.31 |
D1510 | SPACE MAINTAINER - FIXED - UNILATERAL | 520.14 |
D1516 | SPACE MAINTAINER - FIXED - BILATERIAL MAXILLARY | 728.20 |
D1517 | SPACE MAINTAINER - FIXED - BILATERIAL MANDIBULAR | 728.20 |
D1520 | SPACE MAINTAINER - REMOVABLE - UNILATERAL | 572.15 |
D1526 | SPACE MAINTAINER - REMOVABLE - BILATERAL MAXILRY | 884.24 |
D1527 | SPACE MAINTAINER - REMOVABLE - BILATERAL MNDBULR | 884.24 |
D1551 | RECMT/REBND BILAT SPACE MAINTAINER MAXILLARY | 112.35 |
D1552 | RECMT/REBND BILAT SPACE MAINTAINER MANDIBULAR | 112.35 |
D1553 | RECMT/REBND UNI SPACE MAINTAINER PER QUADRANT | 74.90 |
D1556 | REMOVAL FIXED UNI SPACE MAINTAINER PER QUADRANT | 72.82 |
D1557 | REMOVAL FIXED BILAT SPACE MAINTAINER MAXILLARY | 108.19 |
D1558 | REMOVAL FIXED BILAT SPACE MAINTAINER MANDIBULAR | 108.19 |
D1575 | DISTAL SHOE SPACE MAINTANR - FIXED - UNILATERIAL | 572.15 |
D1701 | COVID-19 VACCINE ADMIN-PFIZER-1ST DOSE | 0.00 |
D1702 | COVID-19 VACCINE ADMIN-PFIZER-2ND DOSE | 0.00 |
D1703 | COVID-19 VACCINE ADMIN-MODERNA-1ST DOSE | 0.00 |
D1704 | COVID-19 VACCINE ADMIN-MODERNA-2ND DOSE | 0.00 |
D1705 | COVID-19 VACCINE ADMIN-ASTRAZENECA-1ST DOSE | 0.00 |
D1706 | COVID-19 VACCINE ADMIN-ASTRAZENECA-2ND DOSE | 0.00 |
D1707 | COVID-19 VACCINE ADMIN-JANSSEN | 0.00 |
D1708 | PFIZER-BIONTECH COVID VACC ADMIN THIRD DOSE | 0.00 |
D1709 | PFIZER-BIONTECH COVID VACC ADMIN BOOSTER DOSE | 0.00 |
D1710 | MODERNA COVID VACCINE ADMINISTRATION THIRD DOSE | 0.00 |
D1711 | MODERNA COVID VACCINE ADMINISTRATION BOOSTER DOSE | 0.00 |
D1712 | JANSSEN COVID VACCINE ADMINISTRATION BOOSTER DOSE | 0.00 |
D1713 | PFIZER-BIONTECH COVID VAC ADM TRISCRSE PED FIRST | 0.00 |
D1714 | PFIZER-BIONTECH COVID VAC ADM TRISCRSE PED SECND | 0.00 |
D1781 | VACCINE ADMINSTR HUMAN PAPILLOMAVIRUS DOSE 1 | 0.00 |
D1782 | VACCINE ADMINSTR HUMAN PAPILLOMAVIRUS DOSE 2 | 0.00 |
D1783 | VACCINE ADMINSTR HUMAN PAPILLOMAVIRUS DOSE 3 | 0.00 |
D1999 | UNSPECIFIED PREVENTIVE PROCEDURE BY REPORT | 0.00 |
D2140 | AMALGAM - ONE SURFACE PRIMARY OR PERMANENT | 246.86 |
D2150 | AMALGAM - TWO SURFACES PRIMARY OR PERMANENT | 319.47 |
D2160 | AMALGAM - THREE SURFACES PRIMARY OR PERMANENT | 386.27 |
D2161 | AMALGAM-FOUR/MORE SURFACES PRIMARY/PERMANENT | 470.49 |
D2330 | RESIN-BASED COMPOSITE - ONE SURFACE ANTERIOR | 231.66 |
D2331 | RESIN-BASED COMPOSITE - TWO SURFACES ANTERIOR | 295.64 |
D2332 | RESIN-BASED COMPOSITE - THREE SURFACES ANTERIOR | 361.83 |
D2335 | RESIN BASED COMPOSITE 4/> SURFACES ANTERIOR | 428.02 |
D2390 | RESIN-BASED COMPOSITE CROWN ANTERIOR | 474.35 |
D2391 | RESIN-BASED COMPOSITE - ONE SURFACE POSTERIOR | 271.37 |
D2392 | RESIN-BASED COMPOSITE - TWO SURFACES POSTERIOR | 355.21 |
D2393 | RESIN-BASED COMPOSITE - THREE SURFACES POSTERIOR | 441.26 |
D2394 | RESIN COMPOS - FOUR OR MORE SURFACES POSTERIOR | 540.54 |
D2410 | GOLD FOIL - ONE SURFACE | 405.44 |
D2420 | GOLD FOIL - TWO SURFACES | 675.74 |
D2430 | GOLD FOIL - THREE SURFACES | 1171.28 |
D2510 | INLAY - METALLIC - ONE SURFACE | 1072.17 |
D2520 | INLAY - METALLIC - TWO SURFACES | 1216.33 |
D2530 | INLAY - METALLIC - THREE OR MORE SURFACES | 1401.93 |
D2542 | ONLAY - METALLIC - TWO SURFACES | 1374.90 |
D2543 | ONLAY - METALLIC - THREE SURFACES | 1437.97 |
D2544 | ONLAY - METALLIC - FOUR OR MORE SURFACES | 1495.64 |
D2610 | INLAY - PORCELAIN/CERAMIC - ONE SURFACE | 1261.38 |
D2620 | INLAY - PORCELAIN/CERAMIC - TWO SURFACES | 1331.66 |
D2630 | INLAY - PORCELAIN/CERAMIC - THREE/MORE SURFACES | 1418.15 |
D2642 | ONLAY - PORCELAIN/CERAMIC - TWO SURFACES | 1378.51 |
D2643 | ONLAY - PORCELAIN/CERAMIC - THREE SURFACES | 1486.63 |
D2644 | ONLAY - PORCELAIN/CERAMIC - 4 OR MORE SURFACES | 1576.72 |
D2650 | INLAY - RESIN-BASED COMPOSITE - ONE SURFACE | 828.91 |
D2651 | INLAY - RESIN-BASED COMPOSITE - TWO SURFACES | 987.48 |
D2652 | INLAY RESIN BASED COMPOSITE 3 OR MORE SURFACES | 1037.93 |
D2662 | ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES | 900.99 |
D2663 | ONLAY - RESIN-BASED COMPOSITE - THREE SURFACES | 1059.56 |
D2664 | ONLAY RESIN BASED COMPOSIT FOUR OR MORE SURFACES | 1135.24 |
D2710 | CROWN - RESIN-BASED COMPOSITE (INDIRECT) | 676.31 |
D2712 | CROWN 3/4 RESIN-BASED COMPOSITE (INDIRECT) | 676.31 |
D2720 | CROWN - RESIN WITH HIGH NOBLE METAL | 1666.96 |
D2721 | CROWN - RESIN WITH PREDOMINANTLY BASE METAL | 1562.18 |
D2722 | CROWN - RESIN WITH NOBLE METAL | 1596.47 |
D2740 | CROWN - PORCELAIN/CERAMIC | 1710.78 |
D2750 | CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL | 1687.92 |
D2751 | CROWN - PORCELAIN FUSED PREDOMINANTLY BASE METAL | 1571.71 |
D2752 | CROWN - PORCELAIN FUSED TO NOBLE METAL | 1609.81 |
D2753 | CROWN-PORCELAIN FUSED TITANIUM AND ALLOYS | 1571.71 |
D2780 | CROWN - 3/4 CAST HIGH NOBLE METAL | 1619.34 |
D2781 | CROWN - 3/4 CAST PREDOMINANTLY BASE METAL | 1524.08 |
D2782 | CROWN - 3/4 CAST NOBLE METAL | 1573.61 |
D2783 | CROWN - 3/4 PORCELAIN/CERAMIC | 1665.06 |
D2790 | CROWN - FULL CAST HIGH NOBLE METAL | 1628.86 |
D2791 | CROWN - FULL CAST PREDOMINANTLY BASE METAL | 1543.13 |
D2792 | CROWN - FULL CAST NOBLE METAL | 1571.71 |
D2794 | CROWN - TITANIUM | 1666.96 |
D2799 | PROVISIONAL CROWN | 676.31 |
D2910 | RECMNT/REBND INLAY/ONLAY/VNR/PART CVRGE RESTRATN | 150.82 |
D2915 | RECMNT/REBND INDRCT OR PREFAB POST AND CORE | 150.82 |
D2920 | RE-CEMENT OR RE-BOND CROWN | 152.92 |
D2921 | REATTACHMENT OF TOOTH FRAG INCISAL EDGE/CUSP | 219.95 |
D2928 | PREFAB PORCELAIN/CERAMIC CROWN-PERM TOOTH | 605.38 |
D2929 | PREFABR PORC CROWN - PRIMARY TOOTH | 605.38 |
D2930 | PREFABR STAINLESS STEEL CROWN - PRIMARY TOOTH | 416.85 |
D2931 | PREFABR STAINLESS STEEL CROWN - PERMANENT TOOTH | 471.31 |
D2932 | PREFABRICATED RESIN CROWN | 502.74 |
D2933 | PREFABR STAINLESS STEEL CROWN W/RESIN WINDOW | 576.05 |
D2934 | PREFAB ESTHETIC COAT STNLESS STEEL CROWN PRIM | 576.05 |
D2940 | PROTECTIVE RESTORATION | 159.20 |
D2941 | INTERIM THERAPEUTIC RESTORATION PRIM DENTITION | 159.20 |
D2949 | RESTOR FOUNDATION FOR INDIR RESTOR | 159.20 |
D2950 | CORE BUILDUP INCLUDING ANY PINS WHEN REQUIRED | 398.00 |
D2951 | PIN RETENTION - PER TOOTH ADDITION RESTORATION | 90.07 |
D2952 | POST AND CORE ADDITION TO CROWN INDIRECTLY FAB | 628.42 |
D2953 | EACH ADDITIONAL INDIRECTLY FAB POST SAME TOOTH | 314.21 |
D2954 | PREFABRICATED POST AND CORE IN ADDITION TO CROWN | 502.74 |
D2955 | POST REMOVAL | 387.53 |
D2957 | EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH | 251.37 |
D2960 | LABIAL VENEER (RESIN LAMINATE) - CHAIRSIDE | 1214.94 |
D2961 | LABIAL VENEER (RESIN LAMINATE) - LABORATORY | 1378.33 |
D2962 | LABIAL VENEER (PORCELAIN LAMINATE) - LABORATORY | 1497.73 |
D2971 | ADD PROC CUST CRWN UND XST PART DENTUR FRMEWRK | 240.89 |
D2975 | COPING | 733.16 |
D2976 | BAND STABILIZATION PER TOOTH | 0.00 |
D2980 | CROWN REPAIR MATERIAL FAILURE | 293.26 |
D2981 | INLAY REPAIR BY REPORT | 293.26 |
D2982 | ONLAY REPAIR BY REPORT | 293.26 |
D2983 | VENEER REPAIR BY REPORT | 293.26 |
D2989 | EXCAVATON TOOTH RESULT IN DETERM NON-RESTRABLTY | 0.00 |
D2990 | RESIN INFILT OF INCIPIENT LESIONS | 104.74 |
D2991 | APPLICATION HYDROYAPATITE REGEN MEDICMNT PER TOOTH | 81.69 |
D2999 | UNSPECIFIED RESTORATIVE PROCEDURE BY REPORT | 0.00 |
D3110 | PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION) | 157.01 |
D3120 | PULP CAP - INDIRECT (EXCLUDING FINAL RESTORATION) | 125.61 |
D3220 | TX PULP-REMV PULP CORONAL DENTINOCEMENTL JUNC | 321.88 |
D3221 | PULPAL DEBRIDEMENT PRIMARY AND PERMANENT TEETH | 353.28 |
D3222 | PART PULPOTOMY FOR APEXOGENEIS PERM TOOTH | 327.11 |
D3230 | PULPAL THERAPY - ANTERIOR PRIMARY TOOTH | 296.41 |
D3240 | PULPAL THERAPY - POSTERIOR PRIMARY TOOTH | 364.82 |
D3310 | ENDODONTIC THERAPY ANTERIOR TOOTH | 1162.85 |
D3320 | ENDODONTIC THERAPY PREMOLAR TOOTH | 1425.06 |
D3330 | ENODODONTIC THERAPY MOLAR | 1767.08 |
D3331 | TREATMENT RC OBSTRUCTION; NON-SURGICAL ACCESS | 456.02 |
D3332 | INCOMPLETE ENDO TX; INOP UNRESTORABLE/FX TOOTH | 866.44 |
D3333 | INTERNAL ROOT REPAIR OF PERFORATION DEFECTS | 399.02 |
D3346 | RETIREATMENT PREVIOUS RC THERAPY - ANTERIOR | 1550.47 |
D3347 | RETREATMENT PREVIOUS RC THERAPY - PREMOLAR | 1824.08 |
D3348 | RETREATMENT PREVIOUS ROOT CANAL THERAPY - MOLAR | 2257.30 |
D3351 | APEXIFICATION/RECALCIFICAT INIT VST | 632.79 |
D3352 | APEXIFICATION/RECALCIFICAT INT MED REPL | 283.66 |
D3353 | APEXIFICATION/RECALCIFICATION - FINAL VISIT | 872.81 |
D3355 | PULPAL REGENERATION - INITIAL VISIT | 632.79 |
D3356 | PULPAL REGEN - INTERIM MED RPLCMNT | 283.66 |
D3357 | PULPAL REGENERATION - COMPLETION OF TREATMENT | 0.00 |
D3410 | APICOECTOMY - ANTERIOR | 1254.66 |
D3421 | APICOECTOMY - PREMOLAR (FIRST ROOT) | 1396.49 |
D3425 | APICOECTOMY - MOLAR (FIRST ROOT) | 1581.96 |
D3426 | APICOECTOMY (EACH ADDITIONAL ROOT) | 534.59 |
D3428 | BG IN CONJ PERIRADICULAR SURG/TOOTH SINGLE SITE | 1653.97 |
D3429 | BG IN CONJ PERIRADICUL SURG EACH CONTIG TH SSS | 1577.60 |
D3430 | RETROGRADE FILLING - PER ROOT | 392.76 |
D3431 | BIO MAT SFT OSS REGE CONJ PERIR SUR | 1942.00 |
D3432 | GTR RESORB BRRER PER SITE IN CONJ PERIRAD SURG | 1669.25 |
D3450 | ROOT AMPUTATION - PER ROOT | 818.26 |
D3460 | ENDODONTIC ENDOSSEOUS IMPLANT | 3054.83 |
D3470 | INTENTIONAL REIMPLANTATION W/NECESSARY SPLINTING | 1560.14 |
D3471 | SURGICAL REPAIR ROOT RESORPTION - ANTERIOR | 1942.00 |
D3472 | SURGICAL REPAIR ROOT RESORPTION - PREMOLAR | 1942.00 |
D3473 | SURGICAL REPAIR ROOT RESORPTION - MOLAR | 1942.00 |
D3501 | SRG EXP ROOT WO APICO/RPR ROOT RESORPTN - ANT | 1134.65 |
D3502 | SRG EXP ROOT WO APICO/RPR ROOT RESORPTN-PREMOLAR | 1134.65 |
D3503 | SRG EXP ROOT WO APICO/RPR ROOT RESORPTN-MOLAR | 1134.65 |
D3910 | SURGICAL PROCEDURE ISOLATION TOOTH W/RUBBER DAM | 0.00 |
D3911 | INTRAORIFICE BARRIER | 0.00 |
D3920 | HEMISECTION NOT INCLUDING ROOT CANAL THERAPY | 621.88 |
D3921 | DECORONATION OR SUBMERGENCE ERUPTED TOOTH | 621.88 |
D3950 | CANAL PREPARATION & FITTING PREFORMED DOWEL/POST | 283.66 |
D3999 | UNSPECIFIED ENDODONTIC PROCEDURE BY REPORT | 0.00 |
D4210 | GINGIVECT/PLSTY 4/>CNTIG/TOOTH BOUND SPACES-QUAD | 1268.07 |
D4211 | GINGIVECT/PLSTY 1-3 CNTIG/TOOTH BOUND SPACE-QUAD | 563.59 |
D4212 | GINGIVECT/PLSTY FOR ACCESS RESTORATION PER TOOTH | 450.87 |
D4230 | ANAT CROWN EXP 4/> CONTIGUOUS TEETH PER QUAD | 1775.30 |
D4231 | ANATOMICAL CROWN EXPOSURE 1-3 TEETH PER QUADRANT | 845.38 |
D4240 | GINGL FLP PROC 4/> CONTIG/TOOTH BOUND SPACE-QUAD | 1606.22 |
D4241 | GINGL FLP PROC 1-3 CONTIG/TOOTH BOUND SPACE-QUAD | 929.92 |
D4245 | APICALLY POSITIONED FLAP | 1183.53 |
D4249 | CLINICAL CROWN LENGTHENING - HARD TISSUE | 1761.21 |
D4260 | OSSEOUS SURG 4/> CNTIG TEETH QUAD | 2677.03 |
D4261 | OSSEOUS SURG 1-3 CNTIG TEETH QUAD | 1437.14 |
D4263 | BONE REPLACEMENT GRAFT - FIRST SITE IN QUADRANT | 958.10 |
D4264 | BONE REPLACEMENT GRAFT - EA ADD SITE QUADRANT | 817.20 |
D4265 | BIOLOGIC MATERIALS AID SOFT & OSSEOUS TISSUE REGEN | 0.00 |
D4266 | GUID TISS REGEN NAT TETH RESORB BARRIER PER SITE | 986.28 |
D4267 | GUID TISS REGEN NAT TETH NONRESORB BARR PER SITE | 1268.07 |
D4268 | SURGICAL REVISION PROCEDURE PER TOOTH | 0.00 |
D4270 | PEDICLE SOFT TISSUE GRAFT PROCEDURE | 1902.10 |
D4273 | AUTOGNS CONECTIVE TISSUE GRFT 1ST TOOTH/IMPLANT | 2324.79 |
D4274 | MESIAL OR DISTAL WEDGE PROCEDURE | 1318.79 |
D4275 | NONAUTGNS CONECTV TISSUE GRFT 1ST TOOTH/IMPLANT | 1747.12 |
D4276 | COMB CNCTIVE TISSUE & PEDICLE GRAFT PER TOOTH | 2606.59 |
D4277 | FREE SOFT TISSUE GRAFT, 1ST TOOTH/ IMPLANT | 1972.55 |
D4278 | FREE SOFT TISSUE GRAFT, E/ADNL TOOTH, IMPLNT | 648.12 |
D4283 | AUTO CNNCTV TISSUE GRFT PROC E/A TOOTH, IMPLANT | 1981.00 |
D4285 | NON-AUTO CNNCTV TSSUE GRFT PROC E/A TOOTH/IMPLNT | 1490.68 |
D4286 | REMOVAL OF NON-RESORBABLE BARRIER | 338.15 |
D4322 | SPLINT INTRACORONAL NATURAL TEETH OR PROS CROWN | 652.71 |
D4323 | SPLINT EXTRACORONAL NATURAL TEETH OR PROS CROWN | 593.38 |
D4341 | PRDONTAL SCALING & ROOT PLANING 4/MORE TEETH-QUAD | 375.80 |
D4342 | PRDONTAL SCALING & ROOT PLANING 1-3 TEETH-QUAD | 217.57 |
D4346 | SCALNG GNGIVAL INFLAMM FULL MOUTH AFTR ORAL EVAL | 217.57 |
D4355 | FULL MOUTH DEBRID ENABLE COMP PERIO EVAL & DX | 257.13 |
D4381 | LOC DEL ANTIMICROBL AGTS CREVICULR TISS TOOTH BR | 0.00 |
D4910 | PERIODONTAL MAINTENANCE | 231.42 |
D4920 | UNSCHEDULED DRESSING CHANGE | 168.12 |
D4921 | GINGIVAL IRRIGATION MEDICINAL AGENT PER QUADRANT | 0.00 |
D4999 | UNSPECIFIED PERIODONTAL PROCEDURE BY REPORT | 0.00 |
D5110 | COMPLETE DENTURE - MAXILLARY | 2800.92 |
D5120 | COMPLETE DENTURE - MANDIBULAR | 2800.92 |
D5130 | IMMEDIATE DENTURE - MAXILLARY | 3053.92 |
D5140 | IMMEDIATE DENTURE - MANDIBULAR | 3053.92 |
D5211 | MAXILLARY PARTIAL DENTURE - RESIN BASE | 2363.91 |
D5212 | MANDIBULAR PARTIAL DENTURE - RESIN BASE | 2747.25 |
D5213 | MAX PART DENTUR-CAST METL FRMEWRK W/RSN BASE | 3094.81 |
D5214 | MAND PART DENTUR-CAST METL FRMEWRK W/RSN BASE | 3094.81 |
D5221 | IMMED MAXILLARY PARTIAL DENTURE RESIN BASE | 2578.58 |
D5222 | IMMED MANDIBULAR PARTIAL DENTURE RESIN BASE | 2995.14 |
D5223 | IMMED MAXIL PART DENTURE CAST METL FRAME W/RESIN | 3373.37 |
D5224 | IMMED MAND PART DENTURE CAST METL FRAME W/RESIN | 3373.37 |
D5225 | MAXILLARY PARTIAL DENTRUE FLEXIBLE BASE | 2363.91 |
D5226 | MANDIBULAR PARTIAL DENTURE FLEXIBLE BASE | 2747.25 |
D5227 | IMMED MAXILLARY PARTIAL DENTURE FLEXIBLE BASE | 2581.14 |
D5228 | IMMED MANDIBULAR PARTIAL DENTURE FLEXIBLE BASE | 2990.03 |
D5282 | RMVBL UNIL PRTL DNTR CST MTL INCL CLSP TTH MXLRY | 1804.24 |
D5283 | RMVBL UNIL PRTL DNTR CST MTL INCL CLSP TTH MNDBL | 1804.24 |
D5284 | RMVABLE UNI PRTL DNTURE 1 PC FLEX BASE PER QDRNT | 1377.46 |
D5286 | RMVABLE UNI PRTL DNTURE 1 PC RESIN PER QDRNT | 1377.46 |
D5410 | ADJUST COMPLETE DENTURE - MAXILLARY | 153.33 |
D5411 | ADJUST COMPLETE DENTURE - MANDIBULAR | 153.33 |
D5421 | ADJUST PARTIAL DENTURE - MAXILLARY | 153.33 |
D5422 | ADJUST PARTIAL DENTURE - MANDIBULAR | 153.33 |
D5511 | REPAIR BROKEN COMPLETE DENTURE BASE, MANDIBULAR | 306.67 |
D5512 | REPAIR BROKEN COMPLETE DENTURE BASE, MAXILLARY | 306.67 |
D5520 | REPLACE MISSING/BROKEN TEETH - COMPLETE DENTURE | 255.56 |
D5611 | REPAIR RESIN PARTIAL DENTURE BASE, MANDIBULAR | 332.23 |
D5612 | REPAIR RESIN PARTIAL DENTURE BASE, MAXILLARY | 332.23 |
D5621 | REPAIR CAST FRAMEWORK, MANDIBULAR | 357.78 |
D5622 | REPAIR CAST FRAMEWORK, MAXILLARY | 357.78 |
D5630 | REPAIR OR REPLACE BROKEN CLASP PER TOOTH | 434.45 |
D5640 | REPLACE BROKEN TEETH - PER TOOTH | 281.11 |
D5650 | ADD TOOTH TO EXISTING PARTIAL DENTURE | 383.34 |
D5660 | ADD CLASP TO EXISTING PARTIAL DENTURE PER TOOTH | 460.00 |
D5670 | REPLACE ALL TEETH & ACRYLIC CAST METAL FRMEWRK MAX | 1124.46 |
D5671 | REPLACE ALL TEETH & ACRYLIC CAST METL FRMEWRK MAND | 1124.46 |
D5710 | REBASE COMPLETE MAXILLARY DENTURE | 1137.23 |
D5711 | REBASE COMPLETE MANDIBULAR DENTURE | 1086.12 |
D5720 | REBASE MAXILLARY PARTIAL DENTURE | 1073.34 |
D5721 | REBASE MANDIBULAR PARTIAL DENTURE | 1073.34 |
D5725 | REBASE HYBRID PROSTHESIS | 1137.23 |
D5730 | RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE) | 641.45 |
D5731 | RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) | 641.45 |
D5740 | RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE) | 587.78 |
D5741 | RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE) | 587.78 |
D5750 | RELINE COMPLETE MAXILLARY DENTURE (LABORATORY) | 856.12 |
D5751 | RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY) | 856.12 |
D5760 | RELINE MAXILLARY PARTIAL DENTURE (LABORATORY) | 843.34 |
D5761 | RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY) | 843.34 |
D5765 | SOFT LINER COMPL/PART DENTURE REMOVAL INDIRECT | 856.12 |
D5810 | INTERIM COMPLETE DENTURE (MAXILLARY) | 1354.46 |
D5811 | INTERIM COMPLETE DENTURE (MANDIBULAR) | 1456.68 |
D5820 | INTERIM PARTIAL DENTURE (MAXILLARY) | 1047.79 |
D5821 | INTERIM PARTIAL DENTURE (MANDIBULAR) | 1111.68 |
D5850 | TISSUE CONDITIONING MAXILLARY | 268.34 |
D5851 | TISSUE CONDITIONING MANDIBULAR | 268.34 |
D5862 | PRECISION ATTACHMENT BY REPORT | 0.00 |
D5863 | OVERDENTURE COMPLETE MAXILLARY | 2964.47 |
D5864 | OVERDENTURE PARTIAL MAXILLARY | 3910.04 |
D5865 | OVERDENTURE COMPLETE MIBULAR | 2964.47 |
D5866 | OVERDENTURE PARTIAL MIBULAR | 4063.37 |
D5867 | REPLACEMENT REPL PART SEMI-PRCISN/PRCISN ATTCH | 0.00 |
D5875 | MODIFICATION REMV PROSTH AFTER IMPLANT SURGERY | 0.00 |
D5876 | ADD MTL SUBSTRUCTR TO ACRYLIC FULL DNTR PER ARCH | 0.00 |
D5899 | UNS REMOVABLE PROSTHODONTIC PROCEDURE REPORT | 0.00 |
D5911 | FACIAL MOULAGE (SECTIONAL) | 710.45 |
D5912 | FACIAL MOULAGE (COMPLETE) | 710.45 |
D5913 | NASAL PROSTHESIS | 14960.37 |
D5914 | AURICULAR PROSTHESIS | 14960.37 |
D5915 | ORBITAL PROSTHESIS | 20245.30 |
D5916 | OCULAR PROSTHESIS | 5399.94 |
D5919 | FACIAL PROSTHESIS | 0.00 |
D5922 | NASAL SEPTAL PROSTHESIS | 0.00 |
D5923 | OCULAR PROSTHESIS INTERIM | 0.00 |
D5924 | CRANIAL PROSTHESIS | 0.00 |
D5925 | FACIAL AUGMENTATION IMPLANT PROSTHESIS | 0.00 |
D5926 | NASAL PROSTHESIS REPLACEMENT | 0.00 |
D5927 | AURICULAR PROSTHESIS REPLACEMENT | 0.00 |
D5928 | ORBITAL PROSTHESIS REPLACEMENT | 0.00 |
D5929 | FACIAL PROSTHESIS REPLACEMENT | 0.00 |
D5931 | OBTURATOR PROSTHESIS SURGICAL | 8055.19 |
D5932 | OBTURATOR PROSTHESIS DEFINITIVE | 15065.14 |
D5933 | OBTURATOR PROSTHESIS MODIFICATION | 0.00 |
D5934 | MANDIBULAR RESECTION PROSTHESIS W/GUIDE FLANGE | 13731.13 |
D5935 | MANDIBULAR RESECTION PROSTHESIS W/O GUIDE FLANGE | 11947.34 |
D5936 | OBTURATOR PROSTHESIS INTERIM | 13419.35 |
D5937 | TRISMUS APPLIANCE (NOT FOR TMD TREATMENT) | 1686.68 |
D5951 | FEEDING AID | 2192.69 |
D5952 | SPEECH AID PROSTHESIS PEDIATRIC | 7119.85 |
D5953 | SPEECH AID PROSTHESIS ADULT | 13521.57 |
D5954 | PALATAL AUGMENTATION PROSTHESIS | 12530.01 |
D5955 | PALATAL LIFT PROSTHESIS DEFINITIVE | 11589.56 |
D5958 | PALATAL LIFT PROSTHESIS INTERIM | 0.00 |
D5959 | PALATAL LIFT PROSTHESIS MODIFICATION | 0.00 |
D5960 | SPEECH AID PROSTHESIS MODIFICATION | 0.00 |
D5982 | SURGICAL STENT | 1137.23 |
D5983 | RADIATION CARRIER | 2555.58 |
D5984 | RADIATION SHIELD | 2555.58 |
D5985 | RADIATION CONE LOCATOR | 2555.58 |
D5986 | FLUORIDE GEL CARRIER | 255.56 |
D5987 | COMMISSURE SPLINT | 3833.37 |
D5988 | SURGICAL SPLINT | 766.67 |
D5991 | VESICULOBULLOUS DISEASE MEDICAMENT CARRIER | 293.89 |
D5992 | ADJUST MAXILLOFACIAL PROSTH APPLIANCE BY REPORT | 0.00 |
D5993 | MAINT / CLEAN MAXILLOFACIAL PROSTH BY REPORT | 0.00 |
D5995 | PERIO MEDIC CARRIER PERIPH SEAL LAB PRCESSD MAX | 1405.57 |
D5996 | PERIO MEDIC CARRIER PERIPH SEAL LAB PRCESSD MAN | 1405.57 |
D5999 | UNSPECIFIED MAXILLOFACIAL PROSTHESIS BY REPORT | 0.00 |
D6010 | SURG PLACEMENT IMPLANT BODY: ENDOSTEAL IMPLANT | 3713.26 |
D6011 | SECOND STAGE IMPLANT SURGERY | 0.00 |
D6012 | SURG PLCMT INTERIM IMPL TRNSITIONL PROS: ENDOS | 4421.15 |
D6013 | SURGICAL PLACEMENT OF MINI IMPLANT | 4679.27 |
D6040 | SURGICAL PLACEMENT: EPOSTEAL IMPLANT | 16100.15 |
D6050 | SURGICAL PLACEMENT: TRANSOSTEAL IMPLANT | 12011.23 |
D6051 | INTERIM IMPLANT ABUTMENT | 0.00 |
D6055 | CONNECTING BAR IMPLANT OR ABUTMENT SUPPORTED | 1405.57 |
D6056 | PREFABRICATED ABUTMENT INCLUDES PLACEMENT | 971.12 |
D6057 | CUSTOM FABRICATED ABUTMENT INCLUDES PLACEMENT | 1201.12 |
D6058 | ABUTMENT SUPPORTED PORCELAIN/CERAMIC CROWN | 2693.58 |
D6059 | ABUT SUPP PORCELAIN TO METL CROWN HI NOBLE METL | 2657.80 |
D6060 | ABUT SUPP PORCELAIN TO MTL CROWN PREDOM BASE MTL | 2512.14 |
D6061 | ABUT SUPP PORCELAIN TO METAL CROWN NOBLE METAL | 2563.25 |
D6062 | ABUTMENT SUPP CAST METAL CROWN HIGH NOBLE METAL | 2553.02 |
D6063 | ABUTMENT SUPP CAST METAL CROWN PREDOM BASE METAL | 2223.35 |
D6064 | ABUTMENT SUPP CAST METAL CROWN NOBLE METAL | 2325.58 |
D6065 | IMPL SUPP PORCELAIN/CERAMIC CROWN | 2650.14 |
D6066 | IMPL SUPP PORCLN FUSED METL CRWN TITNM/HIGH NOBL | 2581.14 |
D6067 | IMPL SUPP METAL CROWN TITIANM/HIGH NOBLE METL | 2504.47 |
D6068 | ABUT SUPP RETAINER PORCELAIN/CERAMIC FPD | 2670.58 |
D6069 | ABUT RETAINR PORCELN TO METL FPD HI NOBL METL | 2657.80 |
D6070 | ABUT RETN PORCELN TO METL FPD PREDOM BASE METL | 2512.14 |
D6071 | ABUT SUPP RETN PORCELN FUSD METAL FPD NOBLE METL | 2563.25 |
D6072 | ABUT SUPP RETN CAST METL FPD HIGH NOBLE METL | 2593.91 |
D6073 | ABUT RTNR CAST METL FPD PREDOM BASE METL | 2369.02 |
D6074 | ABUTMENT RTNR CAST METAL FPD NOBLE METAL | 2517.25 |
D6075 | IMPLANT SUPPORTED RETAINER FOR CERAMIC FPD | 2650.14 |
D6076 | IMPL SUPP RTNR PORCLN FUSED METL FPD TITNM/HIGH | 2581.14 |
D6077 | IMPL SUPP RTNR CST METL FPD TITNM/HIGH NOBLE | 2504.47 |
D6080 | IMPL MAINT PROC REMV CLEAN PROSTH & ABUT REINSRT | 219.78 |
D6081 | SCALNG/DBRDMNT IMPLNT WO FLAP ENTRY/CLOS | 112.45 |
D6082 | IMPL SUPP CROWN PORCLN FUSED BASE ALLOY | 2581.14 |
D6083 | IMPL SUPP CROWN PORCLN FUSED TO NOBLE ALLOYS | 2581.14 |
D6084 | IMPL SUPP CROWN PORCLN FUSED TO TITANIUM ALLOYS | 2581.14 |
D6085 | PROVISIONAL IMPLANT CROWN | 771.79 |
D6086 | IMPLANT SUPPORTED CROWN PREDOM BASE ALLOYS | 2504.47 |
D6087 | IMPLANT SUPPORTED CROWN NOBLE ALLOYS | 2504.47 |
D6088 | IMPLNT SUPRTD CROWN TITANIUM AND ALLOYS | 2504.47 |
D6089 | ACCESS AND RETORQU LOOSE IMPLNT SCREW PER SCREW | 0.00 |
D6090 | REPAIR IMPLANT SUPPORTED PROSTHESIS BY REPORT | 0.00 |
D6091 | REPL ATTACHMNT IMPL/ABUT SUPP PROS PER ATTACHMNT | 1060.57 |
D6092 | RECEMENT / REBOND IMPLANT/ABUTMENT SUPP CROWN | 207.00 |
D6093 | RECMNT/REBOND IMPL/ABUTMNT SUPP FIX PART DENTURE | 324.56 |
D6094 | ABUTMENT SUPPORTED CROWN TITANIUM | 2108.35 |
D6095 | REPAIR IMPLANT ABUTMENT BY REPORT | 0.00 |
D6096 | REMOVE BROKEN IMPLANT RETAINING SCREW | 0.00 |
D6097 | ABUT SUPP CROWN PORCLN FUSED TO TITANIUM ALLOYS | 2581.14 |
D6098 | IMPL SUPP RETAINER PORCELAIN FUSED TO BASE ALLOY | 2512.14 |
D6099 | IMPL SUPP RETAINR FPD PORCLN FUSED NOBLE ALLOYS | 2563.25 |
D6100 | SURGICAL REMOVAL IMPLANT BODY | 0.00 |
D6101 | DBRDMNT OF SNGL PERI-IMPLANT DEFECT/S | 759.01 |
D6102 | DBRDMNT AND OSSEOUS CNTUR OF PERI-IMPLANT DEFECT | 1042.68 |
D6103 | BONE GRFT RPR PERIIMPLNT DFCT W/O FLAP ENTR/CLSE | 868.90 |
D6104 | BONE GRAFT AT TIME OF IMPLANT PLACEMENT | 868.90 |
D6105 | RMVL IMPLANT NO BONE REMOVAL OR FLAP ELEVATION | 278.56 |
D6106 | GIDED TISS REGENRATION RESORB BARRIER PER IMPLNT | 894.45 |
D6107 | GIDED TISS REGENRATION NONRESORB BARRIER PER IMP | 1150.01 |
D6110 | IMPL/ABUTMENT SUPPORTED RD - MAXILLARY | 3493.48 |
D6111 | IMPL/ABUTMENT SUPPORTED RD - MANDIBULAR | 3493.48 |
D6112 | IMPL/ABUTMENT SUPPORTED RPD - MAXILLARY | 3493.48 |
D6113 | IMPLANT / ABUTMENT SUPPORTED RPD - MANDIBULAR | 3493.48 |
D6114 | IMPLANT / ABUTMENT SUPPORTED FD - MAXILLARY FULL | 10733.44 |
D6115 | IMPLANT/ABUTMENT SUPPORTED FD - MANDIBULAR FULL | 10733.44 |
D6116 | IMPL/ABUTMENT SUPPORTED FD - MAXILLARY - PARTIAL | 4692.04 |
D6117 | IMPL/ABUT SUPPORTED FD - MANDIBULAR - PARTIAL | 4692.04 |
D6118 | IMP/ABUT SPRTD INTRM FIXED DENTR EDENTLS MANDBLR | 3181.70 |
D6119 | IMP/ABUT SPRTD INTRM FIXED DENTR EDENTLS MAXLARY | 3181.70 |
D6120 | IMPL SUPP RETAINR PORCLN FUSED TITNM AND ALLOYS | 2512.14 |
D6121 | IMPL SUPP RETAINER METAL FPD BASE ALLOYS | 2369.02 |
D6122 | IMPL SUPP RETAINER METAL FPD NOBLE ALLOYS | 2517.25 |
D6123 | IMPL SUPP RETAINR METAL FPD TITNM AND ALLOYS | 2369.02 |
D6190 | RADIOGRAPHIC/SURGICAL IMPLANT INDEX BY REPORT | 472.78 |
D6191 | SEMI-PRECISION ABUTMENT - PLACEMENT | 1983.13 |
D6192 | SEMI-PRECISION ATTACHMENT - PLACEMENT | 1060.57 |
D6194 | ABUTMENT SUPPORTED RETAINER CROWN FOR FPD-TITANM | 2172.24 |
D6195 | ABUT SUPP RETAINR PORCLN FUSED TITANIUM ALLOYS | 2558.14 |
D6197 | RPLC RSTRTV MAT CLOS ACES OPN IPLNT SUPP PRSTSIS | 268.34 |
D6198 | REMOVE INTERIM IMPLANT COMPONENT | 472.78 |
D6199 | UNSPECIFIED IMPLANT PROCEDURE BY REPORT | 0.00 |
D6205 | PONTIC - INDIRECT RESIN BASED COMPOSITE | 1061.99 |
D6210 | PONTIC - CAST HIGH NOBLE METAL | 1623.61 |
D6211 | PONTIC - CAST PREDOMINANTLY BASE METAL | 1521.50 |
D6212 | PONTIC - CAST NOBLE METAL | 1582.77 |
D6214 | PONTIC - TITANIUM | 1633.82 |
D6240 | PONTIC - PORCELAIN FUSED TO HIGH NOBLE METAL | 1603.19 |
D6241 | PONTIC - PORCELN FUSED PREDOMINANTLY BASE METAL | 1480.65 |
D6242 | PONTIC - PORCELAIN FUSED TO NOBLE METAL | 1562.34 |
D6243 | PONTIC PORCELAIN FUSED TO TITANIUM AND ALLOYS | 1480.65 |
D6245 | PONTIC - PORCELAIN/CERAMIC | 1654.25 |
D6250 | PONTIC - RESIN WITH HIGH NOBLE METAL | 1582.77 |
D6251 | PONTIC - RESIN WITH PREDOMINANTLY BASE METAL | 1460.23 |
D6252 | PONTIC - RESIN WITH NOBLE METAL | 1507.20 |
D6253 | PROVISIONAL PONTIC | 682.12 |
D6545 | RETAINER - CAST METAL RESIN BONDED FIX PROSTH | 605.67 |
D6548 | RETAINER - PORCELN/CERAMIC RSN BONDED FIX PROSTH | 666.24 |
D6549 | RESIN RETAINER FOR RESIN BONDED FIXED PROSTHESIS | 436.82 |
D6600 | RETAINER INLAY - PORCELAIN/CERAMIC TWO SURFACES | 1202.17 |
D6601 | RETAINER INLAY - PORC/CERAMIC 3 OR MORE SURFACES | 1260.90 |
D6602 | RETAINER INLAY CAST HIGH NOBLE METAL 2 SURFACES | 1284.76 |
D6603 | RETAINR INLAY - CAST HI NOBLE METAL 3/MORE SURFS | 1413.23 |
D6604 | RETAINER INLAY - CAST PREDOM BASE METAL 2 SURFS | 1259.06 |
D6605 | RTAINR INLAY - CAST PREDOM BASE MTL 3/MORE SURFS | 1334.31 |
D6606 | RETAINER INLAY - CAST NOBLE METAL TWO SURFACES | 1238.87 |
D6607 | RETNR INLAY CAST NOBLE METAL 3 OR MORE SURFACES | 1374.69 |
D6608 | RETAINER ONLAY - PORCELAIN/CERAMIC TWO SURFACES | 1306.78 |
D6609 | RETAINER ONLAY PORCELAIN/CERAMIC 3/MORE SURFACES | 1363.68 |
D6610 | RETAINER ONLAY - HIGH NOBLE METAL TWO SURFACES | 1385.70 |
D6611 | RETAINER ONLAY HIGH NOBLE METAL 3/MORE SURFACES | 1516.02 |
D6612 | RETAINER ONLAY CAST PREDOM BASE METAL 2 SURFACES | 1378.36 |
D6613 | RETNR ONLAY CAST PREDOM BASE METAL 3/MORE SURFS | 1440.77 |
D6614 | RETAINER ONLAY - CAST NOBLE METAL TWO SURFACES | 1349.00 |
D6615 | RETNR ONLAY CAST NOBLE METAL 3 OR MORE SURFACES | 1402.22 |
D6624 | RETAINER INLAY - TITANIUM | 1284.76 |
D6634 | RETAINER ONLAY - TITANIUM | 1349.00 |
D6710 | RETAINER CROWN - INDIRECT RESIN BASED COMPOSITE | 1376.53 |
D6720 | RETAINER CROWN - RESIN WITH HIGH NOBLE METAL | 1605.95 |
D6721 | RETAINER CROWN - RESIN WITH PREDOM BASE METAL | 1523.36 |
D6722 | RETAINER CROWN - RESIN WITH NOBLE METAL | 1550.89 |
D6740 | RETAINER CROWN - PORCELAIN/CERAMIC | 1688.54 |
D6750 | RETNR CROWN PORCELAIN FUSED TO HIGH NOBLE METAL | 1644.49 |
D6751 | RETNR CROWN PORCELAIN FUSED PREDOM BASE METAL | 1534.37 |
D6752 | RETAINER CROWN - PORCELAIN FUSED TO NOBLE METAL | 1571.08 |
D6753 | RETAINR CROWN PORCLN FUSED TO TITANIUM AND ALLOY | 1534.37 |
D6780 | RETAINER CROWN - 3/4 CAST HIGH NOBLE METAL | 1550.89 |
D6781 | RETAINER CROWN 3/4 CAST PREDOMINANTLY BASE METAL | 1550.89 |
D6782 | RETAINER CROWN - 3/4 CAST NOBLE METAL | 1440.77 |
D6783 | RETAINER CROWN - 3/4 PORCELAIN/CERAMIC | 1596.77 |
D6784 | RETAINER CROWN-3/4 TITANIUM AND ALLOYS | 1550.89 |
D6790 | RETAINER CROWN - FULL CAST HIGH NOBLE METAL | 1587.60 |
D6791 | RETAINER CROWN FULL CAST PREDOM BASE METAL | 1505.00 |
D6792 | RETAINER CROWN - FULL CAST NOBLE METAL | 1560.06 |
D6793 | PROVISIONAL RETAINER CROWN | 651.56 |
D6794 | RETAINER CROWN - TITANIUM | 1560.06 |
D6920 | CONNECTOR BAR | 427.14 |
D6930 | RECEMENT / REBOND FIXED PARTIAL DENTURE | 249.16 |
D6940 | STRESS BREAKER | 564.77 |
D6950 | PRECISION ATTACHMENT | 1091.57 |
D6980 | FIXED PARTIAL DENTURE REPAIR MATERIAL FAILURE | 0.00 |
D6985 | PEDIATRIC PARTIAL DENTURE FIXED | 949.19 |
D6999 | UNSPECIFIED FIXED PROSTHODONTIC PROCEDURE REPORT | 0.00 |
D7111 | EXTRACTION CORONAL REMNANTS - PRIMARY TOOTH | 212.32 |
D7140 | EXTRACTION ERUPTED TOOTH OR EXPOSED ROOT | 282.23 |
D7210 | EXTRACTION ERUPTED TOOTH REMV BONE ELEV FLAP | 407.16 |
D7220 | REMOVAL OF IMPACTED TOOTH - SOFT TISSUE | 510.53 |
D7230 | REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY | 679.30 |
D7240 | REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY | 797.44 |
D7241 | REMV IMP TOOTH - CMPL BONY W/UNUSUAL SURG COMPS | 1002.08 |
D7250 | SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS | 430.37 |
D7251 | CORONECTMY INTNTNAL PART TOOTH REMOV IMPCTD OLY | 843.86 |
D7260 | OROANTRAL FISTULA CLOSURE | 3374.47 |
D7261 | PRIMARY CLOSURE OF A SINUS PERFORATION | 1406.03 |
D7270 | TOOTH REIMPL &/OR STBL ACC EVULSED/DISPLCD TOOTH | 1054.52 |
D7272 | TOOTH TRANSPLANTATION | 1406.03 |
D7280 | EXPOSURE OF AN UNERUPTED TOOTH | 984.22 |
D7282 | MOBILIZ ERUPTED/MALPOSITIONED TOOTH AID ERUPTION | 492.11 |
D7283 | PLCMT DEVICE FACILITATE ERUPTION IMPACTED TOOTH | 421.81 |
D7284 | EXCISIONAL BIOPSY OF MINOR SALIVARY GLANDS | 1687.24 |
D7285 | BIOPSY OF ORAL TISSUE HARD | 1968.44 |
D7286 | BIOPSY OF ORAL TISSUE SOFT | 843.62 |
D7287 | EXFOLIATIVE CYTOLOGICAL SAMPLE COLLECTION | 337.45 |
D7288 | BRUSH BIOPSY - TRANSEPITHELIAL SAMPLE COLLECTION | 337.45 |
D7290 | SURGICAL REPOSITIONING OF TEETH | 843.62 |
D7291 | TRANSSEPTAL FIBEROT/SUPRA CRESTAL FIBEROT BR | 0.00 |
D7292 | SURG PLCMT: TEMP ANCHORAGE SCREW RET PLATE FLAP | 1349.79 |
D7293 | SURG PLCMT: TEMP ANCHORAGE DEVICE RQR SURG FLAP | 843.62 |
D7294 | SURG PLCMT: TEMP ANCHORAGE DEVICE W/O SURG FLAP | 703.02 |
D7295 | HARVEST BONE FOR USE AUTOGENOUS GRAFTING PROC | 0.00 |
D7296 | CORTICOTOMY 1 - 3 TEETH OR TOOTH SPACES PER QUAD | 0.00 |
D7297 | CORTCTMY 4 OR MORE TEETH OR TOOTH SPCES PER QUAD | 0.00 |
D7298 | REMOVAL SCREW RETAINED PLATE WITH FLAP | 0.00 |
D7299 | REMOVAL TEMPORARY ANCHORAGE DEVICE WITH FLAP | 0.00 |
D7300 | REMOVAL TEMPORARY ANCHORAGE DEVICE WITHOUT FLAP | 0.00 |
D7310 | ALVEOLOPLASTY W/EXTRACTION 4/> TEETH/SPACE QUAD | 548.44 |
D7311 | ALVEOLOPLSTY CONJNC XTRACT 1-3 TEETH/SPACES QUAD | 479.88 |
D7320 | ALVEOLOPLASTY NOT W/EXTRACTIONS 4/> TEETH/SPACE | 891.21 |
D7321 | ALVEOLOPLSTY NOT CNJNC XTRCT 1-3 TEETH/SPCE QUAD | 754.10 |
D7340 | VESTIBULOPLASTY RIDGE EXT SEC EPITHELIALIZATION | 3770.50 |
D7350 | VESTIBULOPLASTY RIDGE EXT W/SOFT TISS GRAFTS | 10968.72 |
D7410 | EXCISION OF BENIGN LESION UP TO 1.25 CM | 1645.31 |
D7411 | EXCISION OF BENIGN LESION GREATER THAN 1.25 CM | 2605.07 |
D7412 | EXCISION OF BENIGN LESION COMPLICATED | 2879.29 |
D7413 | EXCISION OF MALIGNANT LESION UP TO 1.25 CM | 1919.53 |
D7414 | EXCISION OF MALIGNANT LESION > 1.25 CM | 2879.29 |
D7415 | EXCISION OF MALIGNANT LESION COMPLICATED | 3222.06 |
D7440 | EXC MALIG TUMOR-LESION DIAMETER UP TO 1.25 CM | 2605.07 |
D7441 | EXC MALIG TUMOR-LESION DIAM GREATER THAN 1.25 CM | 3839.05 |
D7450 | REMOVL BENIGN ODONTOGENC CYST/TUMR-UP T0 1.25 CM | 1645.31 |
D7451 | REMOVAL BENIGN ODONTOGENIC CYST/TUMOR- > 1.25 CM | 2248.59 |
D7460 | REMOVAL BEN NONODONTOGENIC CYST/TUMR- UP 1.25 CM | 1645.31 |
D7461 | REMOVAL BEN NONODONTOGENIC CYST/TUMOR > 1.25 CM | 2248.59 |
D7465 | DESTRUCTION LESION PHYSICAL/CHEM METHOD BY REPRT | 891.21 |
D7471 | REMOVAL OF LATERAL EXOSTOSIS | 2037.44 |
D7472 | REMOVAL OF TORUS PALATINUS | 2421.34 |
D7473 | REMOVAL OF TORUS MANDIBULARIS | 2284.24 |
D7485 | REDUCTION OF OSSEOUS TUBEROSITY | 2037.44 |
D7490 | RADICAL RESECTION OF MAXILLA OR MANDIBLE | 16453.08 |
D7509 | MARSUPIALIZATION OF ODONTOGENIC CYST | 891.21 |
D7510 | INCISION & DRAINAGE ABSCESS-INTRAORAL SOFT TISS | 589.57 |
D7511 | I & D ABSCESS INTRAORAL SOFT TISSUE COMPLICATED | 891.21 |
D7520 | INCISION & DRAINAGE ABSCESS-EXTRAORAL SOFT TISS | 2807.99 |
D7521 | I & D ABSCESS EXTRAORAL SOFT TISSUE COMPLICATED | 3084.95 |
D7530 | REMOVAL FB FROM MUCOSA SKIN/SUBCUT ALVEOL TISSUE | 1011.86 |
D7540 | REMV REACT-PRODUC FOREIGN BODIES-MUSCULOSKEL SYS | 1121.55 |
D7550 | PART OSTEC/SEQUESTRECTOMY REMOVAL NON-VITAL BONE | 699.26 |
D7560 | MAXILLARY SINUSOTOMY REMOVAL TOOTH FRAGMENT/FB | 5552.91 |
D7610 | MAXILLA-OPEN REDUCTION | 8980.64 |
D7620 | MAXILLA-CLOSED REDUCTION | 6734.79 |
D7630 | MANDIBLE-OPEN REDUCTION | 11676.20 |
D7640 | MANDIBLE-CLOSED REDUCTION | 7409.37 |
D7650 | MALAR AND/OR ZYGOMATIC ARCH - OPEN REDUCTION | 5613.24 |
D7660 | MALAR AND/OR ZYGOMATIC ARCH - CLOSED REDUCTION | 3309.81 |
D7670 | ALVEOLUS-CLOSED REDUCTION W/STABILIZATION TEETH | 2583.13 |
D7671 | ALVEOLUS-OPEN REDUCTION W/STABILIZATION TEETH | 4867.37 |
D7680 | FACE BONES-COMP RDUC W/FIX&MX SURG APPRCHES CPT | 16839.73 |
D7710 | MAXILLA - OPEN REDUCTION | 10554.65 |
D7720 | MAXILLA - CLOSED REDUCTION | 7409.37 |
D7730 | MANDIBLE - OPEN REDUCTION | 15268.46 |
D7740 | MANDIBLE - CLOSED REDUCTION | 7554.71 |
D7750 | MALAR AND/OR ZYGOMATIC ARCH - OPEN REDUCTION | 9608.60 |
D7760 | MALAR AND/OR ZYGOMATIC ARCH - CLOSED REDUCTION | 3855.51 |
D7770 | ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH | 5223.85 |
D7771 | ALVEOLUS CLOSED REDUCTION STABILIZATION OF TEETH | 4031.00 |
D7780 | FACIAL BONES-COMP RDUC FIX & MULT APPROACHES | 22452.97 |
D7810 | OPEN REDUCTION OF DISLOCATION | 9877.33 |
D7820 | CLOSED REDUCTION OF DISLOCATION | 1617.89 |
D7830 | MANIPULATION UNDER ANESTHESIA | 926.86 |
D7840 | CONDYLECTOMY | 13464.10 |
D7850 | SURGICAL DISCECTOMY WITH/WITHOUT IMPLANT | 11626.84 |
D7852 | DISC REPAIR | 13313.28 |
D7854 | SYNOVECTOMY | 13738.32 |
D7856 | MYOTOMY | 9748.45 |
D7858 | JOINT RECONSTRUCTION | 27786.51 |
D7860 | ARTHROTOMY | 11843.48 |
D7865 | ARTHROPLASTY | 19085.57 |
D7870 | ARTHROCENTESIS | 630.70 |
D7871 | NON-ARTHROSCOPIC LYSIS AND LAVAGE | 1261.40 |
D7872 | ARTHROSCOPY - DIAGNOSIS WITH OR WITHOUT BIOPSY | 6732.05 |
D7873 | ARTHROSCOPY: LAVAGE & LYSIS ADHESIONS | 8105.88 |
D7874 | ARTHROSCOPY: DISC REPSTN & STABILIZATION | 11626.84 |
D7875 | ARTHROSCOPY: SYNOVECTOMY | 12737.43 |
D7876 | ARTHROSCOPY: DISCECTOMY | 13732.84 |
D7877 | ARTHROSCOPY: DEBRIDEMENT | 12120.44 |
D7880 | OCCLUSAL ORTHOTIC DEVICE BY REPORT | 1513.68 |
D7881 | OCCLUSAL ORTHOTIC DEVICE ADJUSTMENT | 164.53 |
D7899 | UNSPECIFIED TMD THERAPY BY REPORT | 0.00 |
D7910 | SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM | 899.44 |
D7911 | COMPLICATED SUTURE - UP TO 5 CM | 2245.85 |
D7912 | COMPLICATED SUTURE - GREATER THAN 5 CM | 4041.97 |
D7920 | SKIN GRAFT | 6622.36 |
D7921 | COLL APPL AUTOLOGOUS BLD CNCNTRT PRODUCT | 611.51 |
D7922 | PLACEMENT INTRASOCKET BIO DRESSING PER SITE | 0.00 |
D7939 | INDEX OSTEOTOMY USING DYNMIC ROBO ASSIST NAVI | 0.00 |
D7940 | OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES | 0.00 |
D7941 | OSTEOTOMY - MANDIBULAR RAMI | 16864.41 |
D7943 | OSTEOT-MANDIB RAMI W/BONE GRFT; INCL OBTAIN GRAFT | 15493.32 |
D7944 | OSTEOTOMY - SEGMENTED OR SUBAPICAL | 13806.88 |
D7945 | OSTEOTOMY - BODY OF MANDIBLE | 18372.61 |
D7946 | LEFORT I (MAXILLA - TOTAL) | 22760.09 |
D7947 | LEFORT I (MAXILLA - SEGMENTED) | 19140.42 |
D7948 | LEFORT II/LEFORT III - W/O BONE GRAFT | 24844.15 |
D7949 | LEFORT II OR LEFORT III - WITH BONE GRAFT | 32357.72 |
D7950 | OSSEOUS OSTEOPERIOSTEAL/CARTILAGE GRAFT MAND/MAX | 0.00 |
D7951 | SINUS AUG WITH BONE OR BONE SUBSTITUTES-LAT APP | 0.00 |
D7952 | SINUS AUGMENTATION VIA A VERTICAL APPROACH | 0.00 |
D7953 | BONE REPLCMT GRAFT RIDGE PRESERVATION PER SITE | 932.34 |
D7955 | REPAIR MAXLOFACIAL SOFT &/ HARD TISSUE DEFECT | 0.00 |
D7956 | GIDED TISS REGENRATION EDENT RESORB BARR PR SITE | 959.76 |
D7957 | GIDED TISS REGENRATION EDENT NONRESORB BARR SITE | 1233.98 |
D7961 | BUCCAL/LABIAL FRENECTOMY (FRENULECTOMY) | 754.10 |
D7962 | LINGUAL FRENECTOMY (FRENULECTOMY) | 754.10 |
D7963 | FRENULOPLASTY | 1233.98 |
D7970 | EXCISION OF HYPERPLASTIC TISSUE - PER ARCH | 1096.87 |
D7971 | EXCISION OF PERICORONAL GINGIVA | 411.33 |
D7972 | SURGICAL REDUCTION OF FIBROUS TUBEROSITY | 1535.62 |
D7979 | NON-SURGICAL SIALOLITHOTOMY | 0.00 |
D7980 | SURGICAL SIALOLITHOTOMY | 1727.57 |
D7981 | EXCISION OF SALIVARY GLAND BY REPORT | 0.00 |
D7982 | SIALODOCHOPLASTY | 4085.85 |
D7983 | CLOSURE OF SALIVARY FISTULA | 3921.32 |
D7990 | EMERGENCY TRACHEOTOMY | 3372.88 |
D7991 | CORONOIDECTOMY | 8226.54 |
D7993 | SURGICAL PLCMNT CRANIOFACIAL IMPLANT-EXTRA ORAL | 0.00 |
D7994 | SURGICAL PLACEMENT ZYGOMATIC IMPLANT | 0.00 |
D7995 | SYNTHETIC GRAFT-MANDIBLE/FACIAL BONES BY REPORT | 0.00 |
D7996 | IMPLANT-MANDIBLE AUGMENTATION PURPOSES BY REPORT | 0.00 |
D7997 | APPLIANCE REMOVAL INCLUDES REMOVAL OF ARCHBAR | 630.70 |
D7998 | INTRAORAL PLCMT FIX DEVICE NOT CONJUNCTION W/FX | 2742.18 |
D7999 | UNSPECIFIED ORAL SURGERY PROCEDURE BY REPORT | 0.00 |
D8010 | LIMITED ORTHODONTIC TREATMENT PRIMARY DENTITION | 0.00 |
D8020 | LTD ORTHODONTIC TREATMENT TRANSITIONAL DENTITION | 0.00 |
D8030 | LTD ORTHODONTIC TREATMENT ADOLESCENT DENTITION | 0.00 |
D8040 | LIMITED ORTHODONTIC TREATMENT ADULT DENTITION | 0.00 |
D8070 | COMP ORTHODONTIC TX TRANSITIONAL DENTITION | 0.00 |
D8080 | COMPREHENSIVE ORTHODONTIC TX ADOLES DENTITION | 0.00 |
D8090 | COMPREHENSIVE ORTHODONTIC TX ADULT DENTITION | 0.00 |
D8210 | REMOVABLE APPLIANCE THERAPY | 0.00 |
D8220 | FIXED APPLIANCE THERAPY | 0.00 |
D8660 | PREORTHODONTIC TREATMENT VISIT | 0.00 |
D8670 | PERIODIC ORTHODONTIC TREATMENT VISIT | 0.00 |
D8680 | ORTHODONTIC RETENTION | 0.00 |
D8681 | REMOVABLE ORTHODONTIC RETAINER ADJUSTMENT | 0.00 |
D8695 | REMOVAL OF FIXED ORTHO APPLIANCES TX NOT COMPLT | 0.00 |
D8696 | REPAIR ORTHODONTIC APPLIANCE MAXILLARY | 0.00 |
D8697 | REPAIR ORTHODONTIC APPLIANCE MANDIBULAR | 0.00 |
D8698 | RE-CEMENT OR RE-BOND FIXED RETAINER MAXILLARY | 0.00 |
D8699 | RE-CEMENT OR RE-BOND FIXED RETAINER MANDIBULAR | 0.00 |
D8701 | REPAIR FIXED RETAINER, WITH REATTACH, MAXILLARY | 0.00 |
D8702 | REPAIR FIXED RETAINER, WITH REATTACH, MANDIBULAR | 0.00 |
D8703 | REPLACE LOST OR BROKEN RETAINER MAXILLARY | 0.00 |
D8704 | REPLACE LOST OR BROKEN RETAINER MANDIBULAR | 0.00 |
D8999 | UNSPECIFIED ORTHODONTIC PROCEDURE BY REPORT | 0.00 |
D9110 | PALLIATIVE TREATMENT OF DENTAL PAIN PER VISIT | 198.53 |
D9120 | FIXED PARTIAL DENTURE SECTIONING | 224.31 |
D9130 | TMJ JOINT DYSFUNCTION - NON-INVASIVE PHYSL THERP | 0.00 |
D9210 | LOCAL ANES-NOT CONJUNCTION W/OP/SURGICAL PROC | 71.53 |
D9211 | REGIONAL BLOCK ANESTHESIA | 78.93 |
D9212 | TRIGEMINAL DIVISION BLOCK ANESTHESIA | 123.32 |
D9215 | LOCAL ANESTHESIA CONJUCTION OPERATIVE/SURG PROC | 59.19 |
D9219 | EVALUATION FOR MOD OR DEEP SEDATION / GA | 140.59 |
D9222 | DEEP SEDATION / GENERAL ANESTHESIA FIRST 15 MIN | 419.30 |
D9223 | DEEP SEDATION/ GEN ANESTH EACH 15 MIN INCREMENT | 320.64 |
D9230 | INHALATION OF NITROUS OXIDE/ANXIOLYSIS ANALGESIA | 118.39 |
D9239 | IV MOD (CONSCIOUS) SEDTION/ANALGSIA FIRST 15 MIN | 345.30 |
D9243 | IV MOD (CONSCIOUS) SEDATION EACH 15 MIN INCRMENT | 271.31 |
D9248 | NON-INTRAVENOUS CONSCIOUS SEDATION | 172.65 |
D9310 | CONSULT DX SERV DENT/PHY NOT REQUESTING DENT/PHY | 279.37 |
D9311 | CONSULT WITH A MEDICAL HEALTHCARE PROFESSIONAL | 279.37 |
D9410 | HOUSE/EXTENDED CARE FACILITY CALL | 319.53 |
D9420 | HOSPITAL OR AMBULATORY SURGICAL CENTER CALL | 516.84 |
D9430 | OFFICE VISIT OBSERVATION NO OTHER SRVC PERFORMED | 0.00 |
D9440 | OFFICE VISIT - AFTER REGULARLY SCHEDULED HOURS | 174.61 |
D9450 | CASE PRESENTATION AFTER DETL & EXTN TREATMENT PLAN | 87.30 |
D9610 | THERAPEUTIC PARENTERAL DRUG SINGL ADMINISTRATION | 0.00 |
D9612 | TX PARENTERAL DRUGS 2/> ADMINISTRATIONS DIFF MED | 0.00 |
D9613 | INFLTRN SUSTND RELSE THRPTIC DRG PER QUADRANT | 0.00 |
D9630 | DRUGS AND/OR MEDICAMENTS BY REPORT, HOME USE | 0.00 |
D9910 | APPLICATION OF DESENSITIZING MEDICAMENT | 104.88 |
D9911 | APPLIC DESENZT RSN CERV & OR ROOT SURF-TOOTH | 146.83 |
D9912 | PRE-VISIT PATIENT SCREENING | 101.88 |
D9920 | BEHAVIOR MANAGEMENT BY REPORT | 0.00 |
D9930 | TX COMPLICATIONS - UNUSUAL CIRCUMSTANCES REPORT | 0.00 |
D9932 | CLEAN/INSPECT REMOVBL COMPLETE MAXILLARY DENTURE | 257.70 |
D9933 | CLEAN INSPECT REMVBL COMPLETE MANDIBULAR DENTURE | 257.70 |
D9934 | CLEAN/ INSPECT REMVBL PARTIAL MAXILLARY DENTURE | 257.70 |
D9935 | CLEAN INSPECT REMVBL PARTIAL MANDIBULAR DENTURE | 257.70 |
D9938 | FABR CUST REMVBLE CLER PLAST TEMP ASTHETC APLNCE | 0.00 |
D9939 | PLACE CUST REMVBLE CLER PLAST TEMP ASTHTC APLNCE | 0.00 |
D9941 | FABRICATION OF ATHLETIC MOUTHGUARD | 299.65 |
D9942 | REPAIR AND/OR RELINE OF OCCLUSAL GUARD | 359.58 |
D9943 | OCCLUSAL GUARD ADJUSTMENT | 179.79 |
D9944 | OCCLUSAL GUARD - HARD APPLIANCE, FULL ARCH | 868.98 |
D9945 | OCCLUSAL GUARD - SOFT APPLIANCE, FULL ARCH | 868.98 |
D9946 | OCCLUSAL GUARD HARD APPLIANCE PARTIAL ARCH | 868.98 |
D9947 | CUSTOM SLEEP APNEA APPLIANCE FABRCATION/PLACEMNT | 0.00 |
D9948 | ADJUSTMENT CUSTOM SLEEP APNEA APPLIANCE | 0.00 |
D9949 | REPAIR CUSTOM SLEEP APNEA APPLIANCE | 0.00 |
D9950 | OCCLUSION ANALYSIS - MOUNTED CASE | 569.33 |
D9951 | OCCLUSAL ADJUSTMENT - LIMITED | 254.70 |
D9952 | OCCLUSAL ADJUSTMENT - COMPLETE | 1198.60 |
D9953 | RELINE CUSTOM SLEEP APNEA APPLIANCE (INDIRECT) | 988.84 |
D9954 | FABRIC AND DELIV OAT MORNING REPOSITION DEVICE | 0.00 |
D9955 | ORAL APPLIANCE THERAPY (OAT) TITRATION VISIT | 0.00 |
D9956 | ADMINISTRATION OF HOME SLEEP APNEA TEST | 0.00 |
D9957 | SCREENING FOR SLEEP RELATED BREATHING DISORDERS | 0.00 |
D9961 | DUPLICATE/COPY PATIENT'S RECORDS | 0.00 |
D9970 | ENAMEL MICROABRASION | 134.84 |
D9971 | ODONTOPLASTY 1-2 TEETH; INCL REMOVAL ENAMEL PROJ | 173.80 |
D9972 | EXTERNAL BLEACHING - PER ARCH | 599.30 |
D9973 | EXTERNAL BLEACHING - PER TOOTH | 98.88 |
D9974 | INTERNAL BLEACHING - PER TOOTH | 524.39 |
D9975 | EXTERNAL BLEACHING - PER ARCH (HOME) | 599.30 |
D9985 | SALES TAX | 0.00 |
D9986 | MISSED APPOINTMENT | 0.00 |
D9987 | CANCELLED APPOINTMENT | 0.00 |
D9990 | CERT TRNSLATION OR SIGN LANGUAGE SRVCS PER VISIT | 0.00 |
D9991 | DENTAL CASE MGMT ADDRESS APPNTMNT COMPL BARRIERS | 0.00 |
D9992 | DENTAL CASE MANAGEMENT - CARE COORDINATION | 104.88 |
D9993 | DENTAL CASE MGMT - MOTIVATIONAL INTERVIEWING | 0.00 |
D9994 | DENTAL CASE MGMT - PATIENT EDU IMPRV ORAL HEALTH | 0.00 |
D9995 | TELEDENTISTRY - SYNCHRONOUS; REAL TIME ENCOUNTER | 479.44 |
D9996 | TELDENTRY ASYNCHRNS INFO FWD DENTIST SBSQNT REVW | 359.58 |
D9997 | DENTAL CASE MANAGEMENT SPECIAL HEALTH CARE NEEDS | 0.00 |
D9999 | UNSPECIFIED ADJUNCTIVE PROC BY REPORT (01/24) | By Report |
7 CCR 1101-3 R18 Exhibits, exh. #3