20 Miss. Code. R. 2-II
Services provided by other dental practitioners, including hygienists and dental assistants, must be billed by the licensed dentist, orthodontist or oral surgeon overseeing these practitioners.
Code | Description | Amount |
D0120 | PERIODIC ORAL EVALUATION - ESTABLISHED PATIENT | 49.00 |
D0140 | LIMITED ORAL EVALUATION - PROBLEM FOCUSED | 72.00 |
D0145 | ORAL EVALUATION FOR A PATIENT UNDER THREE YEARS OF AGE AND COUNSELING WITH PRIMARY CAREGIVER | 65.00 |
D0150 | COMPREHENSIVE ORAL EVALUATION - NEW OR ESTABLISHED PATIENT | 79.00 |
D0160 | DETAILED AND EXTENSIVE ORAL EVALUATION - PROBLEM FOCUSED, BY REPORT | BR |
D0170 | RE-EVALUATION - LIMITED, PROBLEM FOCUSED (ESTABLISHED PATIENT; NOT POST-OPERATIVE VISIT) | 69.00 |
D0171 | RE-EVALUATION - POST-OPERATIVE OFFICE VISIT | 64.00 |
D0180 | COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT | 101.00 |
D0190 | SCREENING OF A PATIENT | 40.00 |
D0191 | ASSESSMENT OF A PATIENT | 30.00 |
D0210 | INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES | 135.00 |
D0220 | INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE | 28.00 |
D0230 | INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE | 24.00 |
D0240 | INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE | 35.00 |
D0250 | EXTRA-ORAL - 2D PROJECTION RADIOGRAPHIC IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR | 49.00 |
D0251 | EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE | 35.00 |
D0270 | BITEWING - SINGLE RADIOGRAPHIC IMAGE | 29.00 |
D0272 | BITEWINGS - TWO RADIOGRAPHIC IMAGES | 43.00 |
D0273 | BITEWINGS - THREE RADIOGRAPHIC IMAGES | 53.00 |
D0274 | BITEWINGS - FOUR RADIOGRAPHIC IMAGES | 60.00 |
D0277 | VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES | 92.00 |
D0310 | SIALOGRAPHY | 413.33 |
D0320 | TEMPOROMANDIBULAR JOINT ARTHROGRAM, INCLUDING INJECTION | 730.22 |
D0321 | OTHER TEMPOROMANDIBULAR JOINT RADIOGRAPHIC IMAGES, BY REPORT | BR |
D0322 | TOMOGRAPHIC SURVEY | 592.45 |
D0330 | PANORAMIC RADIOGRAPHIC IMAGE | 109.00 |
D0340 | 2D CEPHALOMETRIC RADIOGRAPHIC IMAGE - ACQUISITION, MEASUREMENT AND ANALYSIS | 99.00 |
D0350 | 2D ORAL/FACIAL PHOTOGRAPHIC IMAGE OBTAINED INTRA-ORALLY OR EXTRA-ORALLY | 50.00 |
D0351 | 3D PHOTOGRAPHIC IMAGE | 55.00 |
D0364 | CONE BEAM CT CAPTURE AND INTERPRETATION WITH LIMITED FIELD OF VIEW - LESS THAN ONE WHOLE JAW | 195.00 |
D0365 | CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF ONE FULL DENTAL ARCH - MANDIBLE | 185.00 |
D0366 | CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF ONE FULL DENTAL ARCH - MAXILLA, WITH OR WITHOUT CRANIUM | 318.50 |
D0367 | CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF BOTH JAWS; WITH OR WITHOUT CRANIUM | 297.00 |
D0368 | CONE BEAM CT CAPTURE AND INTERPRETATION FOR TMJ SERIES INCLUDING TWO OR MORE EXPOSURES | 340.31 |
D0369 | MAXILLOFACIAL MRI CAPTURE AND INTERPRETATION | 192.89 |
D0370 | MAXILLOFACIAL ULTRASOUND CAPTURE AND INTERPRETATION | 110.22 |
D0371 | SIALOENDOSCOPY CAPTURE AND INTERPRETATION | BR |
D0380 | CONE BEAM CT IMAGE CAPTURE WITH LIMITED FIELD OF VIEW - LESS THAN ONE WHOLE JAW | 85.00 |
D0381 | CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF ONE FULL DENTAL ARCH - MANDIBLE | 180.00 |
D0382 | CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF ONE FULL DENTAL ARCH - MAXILLA, WITH OR WITHOUT CRANIUM | 321.02 |
D0383 | CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF BOTH JAWS; WITH OR WITHOUT CRANIUM | 200.00 |
D0384 | CONE BEAM CT IMAGE CAPTURE FOR TMJ SERIES INCLUDING TWO OR MORE EXPOSURES | 344.45 |
D0385 | MAXILLOFACIAL MRI IMAGE CAPTURE | 2114.89 |
D0386 | MAXILLOFACIAL ULTRASOUND IMAGE CAPTURE | 529.07 |
D0391 | INTERPRETATION OF DIAGNOSTIC IMAGE BY A PRACTITIONER NOT ASSOCIATED WITH CAPTURE OF THE IMAGE, INCLUDING REPORT | BR |
D0393 | TREATMENT SIMULATION USING 3D IMAGE VOLUME | BR |
D0394 | DIGITAL SUBTRACTION OF TWO OR MORE IMAGES OR IMAGE VOLUMES OF THE SAME MODALITY | BR |
D0395 | FUSION OF TWO OR MORE 3D IMAGE VOLUMES OF ONE OR MORE MODALITIES | BR |
D0411 | HBA1C IN-OFFICE POINT OF SERVICE TESTING | BR |
D0412 | BLOOD GLUCOSE LEVEL TEST - IN-OFFICE USING A GLUCOSE METER | BR |
D0414 | LABORATORY PROCESSING OF MICROBIAL SPECIMEN TO INCLUDE CULTURE AND SENSITIVITY STUDIES, PREPARATION AND TRANSMISSION OF WRITTEN REPORT | 55.11 |
D0415 | COLLECTION OF MICROORGANISMS FOR CULTURE AND SENSITIVITY | 65.00 |
D0416 | VIRAL CULTURE | 59.24 |
D0417 | COLLECTION AND PREPARATION OF SALIVA SAMPLE FOR LABORATORY DIAGNOSTIC TESTING | 65.00 |
D0418 | ANALYSIS OF SALIVA SAMPLE | 65.00 |
D0422 | COLLECTION AND PREPARATION OF GENETIC SAMPLE MATERIAL FOR LABORATORY ANALYSIS AND REPORT | 39.96 |
D0423 | GENETIC TEST FOR SUSCEPTIBILITY TO DISEASES - SPECIMEN ANALYSIS | BR |
D0425 | CARIES SUSCEPTIBILITY TESTS | 34.44 |
D0431 | ADJUNCTIVE PRE-DIAGNOSTIC TEST THAT AIDS IN DETECTION OF MUCOSAL ABNORMALITIES INCLUDING PREMALIGNANT AND MALIGNANT LESIONS, NOT TO INCLUDE CYTOLOGY OR BIOPSY PROCEDURES | 31.00 |
D0460 | PULP VITALITY TESTS | 53.00 |
D0470 | DIAGNOSTIC CASTS | 102.00 |
D0472 | ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT | 75.78 |
D0473 | ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT | 159.82 |
D0474 | ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, INCLUDING ASSESSMENT OF SURGICAL MARGINS FOR PRESENCE OF DISEASE, PREPARATION AND TRANSMISSION OF WRITTEN REPORT | 179.11 |
D0475 | DECALCIFICATION PROCEDURE | 96.44 |
D0476 | SPECIAL STAINS FOR MICROORGANISMS | 93.69 |
D0477 | SPECIAL STAINS, NOT FOR MICROORGANISMS | 128.13 |
D0478 | IMMUNOHISTOCHEMICAL STAINS | 117.11 |
D0479 | TISSUE IN-SITU HYBRIDIZATION, INCLUDING INTERPRETATION | 179.11 |
D0480 | ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT | 110.22 |
D0481 | ELECTRON MICROSCOPY | 413.33 |
D0482 | DIRECT IMMUNOFLUORESCENCE | 137.78 |
D0483 | INDIRECT IMMUNOFLUORESCENCE | 137.78 |
D0484 | CONSULTATION ON SLIDES PREPARED ELSEWHERE | 206.67 |
D0485 | CONSULTATION, INCLUDING PREPARATION OF SLIDES FROM BIOPSY MATERIAL SUPPLIED BY REFERRING SOURCE | 285.20 |
D0486 | LABORATORY ACCESSION OF TRANSEPITHELIAL CYTOLOGIC SAMPLE, MICROSCOPIC EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT | 132.27 |
D0502 | OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT | BR |
D0600 | NON-IONIZING DIAGNOSTIC PROCEDURE CAPABLE OF QUANTIFYING, MONITORING, AND RECORDING CHANGES IN STRUCTURE OF ENAMEL, DENTIN, AND CEMENTUM | 25.00 |
D0601 | CARIES RISK ASSESSMENT AND DOCUMENTATION, WITH A FINDING OF LOW RISK | 10.00 |
D0602 | CARIES RISK ASSESSMENT AND DOCUMENTATION, WITH A FINDING OF MODERATE RISK | 82.67 |
D0603 | CARIES RISK ASSESSMENT AND DOCUMENTATION, WITH A FINDING OF HIGH RISK | 82.67 |
D0999 | UNSPECIFIED DIAGNOSTIC PROCEDURE, BY REPORT | BR |
D1110 | PROPHYLAXIS - ADULT | 85.00 |
D1120 | PROPHYLAXIS - CHILD | 67.00 |
D1206 | TOPICAL APPLICATION OF FLUORIDE VARNISH | 45.00 |
D1208 | TOPICAL APPLICATION OF FLUORIDE - EXCLUDING VARNISH | 35.00 |
D1310 | NUTRITIONAL COUNSELING FOR CONTROL OF DENTAL DISEASE | 72.00 |
D1320 | TOBACCO COUNSELING FOR THE CONTROL AND PREVENTION OF ORAL DISEASE | 46.03 |
D1330 | ORAL HYGIENE INSTRUCTIONS | 65.00 |
D1351 | SEALANT - PER TOOTH | 54.00 |
D1352 | PREVENTIVE RESIN RESTORATION IN A MODERATE TO HIGH CARIES RISK PATIENT - PERMANENT TOOTH | 68.00 |
D1353 | SEALANT REPAIR - PER TOOTH | 60.56 |
D1354 | INTERIM CARIES ARRESTING MEDICAMENT APPLICATION - PER TOOTH | 31.00 |
D1510 | SPACE MAINTAINER - FIXED - UNILATERAL | 328.00 |
D1516 | SPACE MAINTAINER - FIXED - BILATERAL, MAXILLARY | 423.94 |
D1517 | SPACE MAINTAINER - FIXED - BILATERAL, MANDIBULAR | 423.94 |
D1520 | SPACE MAINTAINER - REMOVABLE - UNILATERAL | 339.00 |
D1526 | SPACE MAINTAINER - REMOVABLE - BILATERAL, MAXILLARY | 514.79 |
D1527 | SPACE MAINTAINER - REMOVABLE - BILATERAL, MANDIBULAR | 514.79 |
D1550 | RE-CEMENT OR RE-BOND SPACE MAINTAINER | 84.00 |
D1555 | REMOVAL OF FIXED SPACE MAINTAINER | 77.00 |
D1575 | DISTAL SHOE SPACE MAINTAINER - FIXED - UNILATERAL | 333.10 |
D1999 | UNSPECIFIED PREVENTIVE PROCEDURE, BY REPORT | BR |
D2140 | AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT | 132.00 |
D2150 | AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT | 164.00 |
D2160 | AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT | 195.00 |
D2161 | AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT | 220.00 |
D2330 | RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR | 154.00 |
D2331 | RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR | 185.00 |
D2332 | RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR | 225.00 |
D2335 | RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR) | 275.00 |
D2390 | RESIN-BASED COMPOSITE CROWN, ANTERIOR | 357.00 |
D2391 | RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR | 167.00 |
D2392 | RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR | 215.00 |
D2393 | RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR | 261.00 |
D2394 | RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR | 309.00 |
D2410 | GOLD FOIL - ONE SURFACE | 301.91 |
D2420 | GOLD FOIL - TWO SURFACES | 503.18 |
D2430 | GOLD FOIL - THREE SURFACES | 872.18 |
D2510 | INLAY - METALLIC - ONE SURFACE | 798.38 |
D2520 | INLAY - METALLIC - TWO SURFACES | 905.73 |
D2530 | INLAY - METALLIC - THREE OR MORE SURFACES | 1043.94 |
D2542 | ONLAY - METALLIC - TWO SURFACES | 1023.81 |
D2543 | ONLAY - METALLIC - THREE SURFACES | 1070.77 |
D2544 | ONLAY - METALLIC - FOUR OR MORE SURFACES | 1113.71 |
D2610 | INLAY - PORCELAIN/CERAMIC - ONE SURFACE | 939.27 |
D2620 | INLAY - PORCELAIN/CERAMIC - TWO SURFACES | 991.60 |
D2630 | INLAY - PORCELAIN/CERAMIC - THREE OR MORE SURFACES | 1056.01 |
D2642 | ONLAY - PORCELAIN/CERAMIC - TWO SURFACES | 1026.49 |
D2643 | ONLAY - PORCELAIN/CERAMIC - THREE SURFACES | 992.00 |
D2644 | ONLAY - PORCELAIN/CERAMIC - FOUR OR MORE SURFACES | 950.00 |
D2650 | INLAY - RESIN-BASED COMPOSITE - ONE SURFACE | 617.24 |
D2651 | INLAY - RESIN-BASED COMPOSITE - TWO SURFACES | 735.32 |
D2652 | INLAY - RESIN-BASED COMPOSITE - THREE OR MORE SURFACES | 772.89 |
D2662 | ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES | 670.91 |
D2663 | ONLAY - RESIN-BASED COMPOSITE - THREE SURFACES | 788.99 |
D2664 | ONLAY - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES | 845.35 |
D2710 | CROWN - RESIN-BASED COMPOSITE (INDIRECT) | 476.35 |
D2712 | CROWN - 3/4 RESIN-BASED COMPOSITE (INDIRECT) | 476.35 |
D2720 | CROWN - RESIN WITH HIGH NOBLE METAL | 1174.09 |
D2721 | CROWN - RESIN WITH PREDOMINANTLY BASE METAL | 1100.29 |
D2722 | CROWN - RESIN WITH NOBLE METAL | 1124.45 |
D2740 | CROWN - PORCELAIN/CERAMIC | 1072.00 |
D2750 | CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL | 998.00 |
D2751 | CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL | 957.00 |
D2752 | CROWN - PORCELAIN FUSED TO NOBLE METAL | 1017.00 |
D2780 | CROWN - 3/4 CAST HIGH NOBLE METAL | 1140.55 |
D2781 | CROWN - 3/4 CAST PREDOMINANTLY BASE METAL | 1073.46 |
D2782 | CROWN - 3/4 CAST NOBLE METAL | 260.00 |
D2783 | CROWN - 3/4 PORCELAIN/CERAMIC | 1145.00 |
D2790 | CROWN - FULL CAST HIGH NOBLE METAL | 1100.00 |
D2791 | CROWN - FULL CAST PREDOMINANTLY BASE METAL | 898.50 |
D2792 | CROWN - FULL CAST NOBLE METAL | 995.00 |
D2794 | CROWN - TITANIUM | 1174.09 |
D2799 | PROVISIONAL CROWN- FURTHER TREATMENT OR COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO FINAL IMPRESSION | 365.00 |
D2910 | RE-CEMENT OR RE-BOND INLAY, ONLAY, VENEER OR PARTIAL COVERAGE RESTORATION | 109.00 |
D2915 | RE-CEMENT OR RE-BOND INDIRECTLY FABRICATED OR PREFABRICATED POST AND CORE | 120.00 |
D2920 | RE-CEMENT OR RE-BOND CROWN | 95.00 |
D2921 | REATTACHMENT OF TOOTH FRAGMENT, INCISAL EDGE OR CUSP | 140.89 |
D2929 | PREFABRICATED PORCELAIN/CERAMIC CROWN - PRIMARY TOOTH | 500.00 |
D2930 | PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH | 265.00 |
D2931 | PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH | 312.00 |
D2932 | PREFABRICATED RESIN CROWN | 322.04 |
D2933 | PREFABRICATED STAINLESS STEEL CROWN WITH RESIN WINDOW | 445.00 |
D2934 | PREFABRICATED ESTHETIC COATED STAINLESS STEEL CROWN - PRIMARY TOOTH | 308.00 |
D2940 | PROTECTIVE RESTORATION | 109.00 |
D2941 | INTERIM THERAPEUTIC RESTORATION - PRIMARY DENTITION | 101.98 |
D2949 | RESTORATIVE FOUNDATION FOR AN INDIRECT RESTORATION | 101.98 |
D2950 | CORE BUILDUP, INCLUDING ANY PINS WHEN REQUIRED | 254.00 |
D2951 | PIN RETENTION - PER TOOTH, IN ADDITION TO RESTORATION | 60.00 |
D2952 | POST AND CORE IN ADDITION TO CROWN, INDIRECTLY FABRICATED | 366.00 |
D2953 | EACH ADDITIONAL INDIRECTLY FABRICATED POST - SAME TOOTH | 201.27 |
D2954 | PREFABRICATED POST AND CORE IN ADDITION TO CROWN | 327.00 |
D2955 | POST REMOVAL | 175.00 |
D2957 | EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH | 136.00 |
D2960 | LABIAL VENEER (RESIN LAMINATE) - CHAIRSIDE | 500.00 |
D2961 | LABIAL VENEER (RESIN LAMINATE) - LABORATORY | 882.92 |
D2962 | LABIAL VENEER (PORCELAIN LAMINATE) - LABORATORY | 1131.00 |
D2971 | ADDITIONAL PROCEDURES TO CONSTRUCT NEW CROWN UNDER EXISTING PARTIAL DENTURE FRAMEWORK | 178.00 |
D2975 | COPING | 40.00 |
D2980 | CROWN REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE | 220.00 |
D2981 | INLAY REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE | 187.85 |
D2982 | ONLAY REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE | 187.85 |
D2983 | VENEER REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE | 187.85 |
D2990 | RESIN INFILTRATION OF INCIPIENT SMOOTH SURFACE LESIONS | 145.00 |
D2999 | UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT | BR |
D3110 | PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION) | 74.00 |
D3120 | PULP CAP - INDIRECT (EXCLUDING FINAL RESTORATION) | 73.00 |
D3220 | THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT | 186.00 |
D3221 | PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH | 190.00 |
D3222 | PARTIAL PULPOTOMY FOR APEXOGENESIS - PERMANENT TOOTH WITH INCOMPLETE ROOT DEVELOPMENT | 176.00 |
D3230 | PULPAL THERAPY (RESORBABLE FILLING) - ANTERIOR, PRIMARY TOOTH (EXCLUDING FINAL RESTORATION) | 280.00 |
D3240 | PULPAL THERAPY (RESORBABLE FILLING) - POSTERIOR, PRIMARY TOOTH (EXCLUDING FINAL RESTORATION) | 260.00 |
D3310 | ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION) | 772.00 |
D3320 | ENDODONTIC THERAPY, PREMOLAR TOOTH (EXCLUDING FINAL RESTORATION) | 898.00 |
D3330 | ENDODONTIC THERAPY, MOLAR TOOTH (EXCLUDING FINAL RESTORATION) | 1025.00 |
D3331 | TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS | 210.00 |
D3332 | INCOMPLETE ENDODONTIC THERAPY; INOPERABLE, UNRESTORABLE OR FRACTURED TOOTH | 450.00 |
D3333 | INTERNAL ROOT REPAIR OF PERFORATION DEFECTS | 246.40 |
D3346 | RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - ANTERIOR | 1010.00 |
D3347 | RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - PREMOLAR | 1125.00 |
D3348 | RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - MOLAR | 1275.00 |
D3351 | APEXIFICATION/RECALCIFICATION - INITIAL VISIT (APICAL CLOSURE / CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.) | 250.00 |
D3352 | APEXIFICATION/RECALCIFICATION - INTERIM MEDICATION REPLACEMENT | 183.04 |
D3353 | APEXIFICATION/RECALCIFICATION - FINAL VISIT (INCLUDES COMPLETED ROOT CANAL THERAPY - APICAL CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.) | 563.20 |
D3355 | PULPAL REGENERATION - INITIAL VISIT | 408.32 |
D3356 | PULPAL REGENERATION - INTERIM MEDICATION REPLACEMENT | 183.04 |
D3357 | PULPAL REGENERATION - COMPLETION OF TREATMENT | BR |
D3410 | APICOECTOMY - ANTERIOR | 835.00 |
D3421 | APICOECTOMY - PREMOLAR (FIRST ROOT) | 985.00 |
D3425 | APICOECTOMY - MOLAR (FIRST ROOT) | 850.00 |
D3426 | APICOECTOMY (EACH ADDITIONAL ROOT) | 344.96 |
D3427 | PERIRADICULAR SURGERY WITHOUT APICOECTOMY | 732.16 |
D3428 | BONE GRAFT IN CONJUNCTION WITH PERIRADICULAR SURGERY - PER TOOTH, SINGLE SITE | 1067.26 |
D3429 | BONE GRAFT IN CONJUNCTION WITH PERIRADICULAR SURGERY - EACH ADDITIONAL CONTIGUOUS TOOTH IN THE SAME SURGICAL SITE | 1017.98 |
D3430 | RETROGRADE FILLING - PER ROOT | 228.00 |
D3431 | BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION IN CONJUNCTION WITH PERIRADICULAR SURGERY | 1253.12 |
D3432 | GUIDED TISSUE REGENERATION, RESORBABLE BARRIER, PER SITE, IN CONJUNCTION WITH PERIRADICULAR SURGERY | 1077.12 |
D3450 | ROOT AMPUTATION - PER ROOT | 528.00 |
D3460 | ENDODONTIC ENDOSSEOUS IMPLANT | 1971.20 |
D3470 | INTENTIONAL REIMPLANTATION (INCLUDING NECESSARY SPLINTING) | 1006.72 |
D3910 | SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM | 140.80 |
D3920 | HEMISECTION (INCLUDING ANY ROOT REMOVAL), NOT INCLUDING ROOT CANAL THERAPY | 401.28 |
D3950 | CANAL PREPARATION AND FITTING OF PREFORMED DOWEL OR POST | 183.04 |
D3999 | UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT | BR |
D4210 | GINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT | 950.00 |
D4211 | GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT | 270.00 |
D4212 | GINGIVECTOMY OR GINGIVOPLASTY TO ALLOW ACCESS FOR RESTORATIVE PROCEDURE, PER TOOTH | 138.00 |
D4230 | ANATOMICAL CROWN EXPOSURE - FOUR OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT | 802.42 |
D4231 | ANATOMICAL CROWN EXPOSURE - ONE TO THREE TEETH OR TOOTH BOUNDED SPACES PER QUADRANT | 350.00 |
D4240 | GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT | 1200.00 |
D4241 | GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT | 597.60 |
D4245 | APICALLY POSITIONED FLAP | 534.95 |
D4249 | CLINICAL CROWN LENGTHENING - HARD TISSUE | 673.00 |
D4260 | OSSEOUS SURGERY (INCLUDING ELEVATION OF A FULL THICKNESS FLAP AND CLOSURE) - FOUR OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT | 1299.00 |
D4261 | OSSEOUS SURGERY (INCLUDING ELEVATION OF A FULL THICKNESS FLAP AND CLOSURE) - ONE TO THREE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT | 915.00 |
D4263 | BONE REPLACEMENT GRAFT - RETAINED NATURAL TOOTH - FIRST SITE IN QUADRANT | 450.00 |
D4264 | BONE REPLACEMENT GRAFT - RETAINED NATURAL TOOTH - EACH ADDITIONAL SITE IN QUADRANT | 506.00 |
D4265 | BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION | 375.00 |
D4266 | GUIDED TISSUE REGENERATION - RESORBABLE BARRIER, PER SITE | 425.00 |
D4267 | GUIDED TISSUE REGENERATION - NONRESORBABLE BARRIER, PER SITE (INCLUDES MEMBRANE REMOVAL) | 350.00 |
D4268 | SURGICAL REVISION PROCEDURE, PER TOOTH | BR |
D4270 | PEDICLE SOFT TISSUE GRAFT PROCEDURE | 440.00 |
D4273 | AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE (INCLUDING DONOR AND RECIPIENT SURGICAL SITES) FIRST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT | 1200.00 |
D4274 | MESIAL/DISTAL WEDGE PROCEDURE, SINGLE TOOTH (WHEN NOT PERFORMED IN CONJUNCTION WITH SURGICAL PROCEDURES IN THE SAME ANATOMICAL AREA) | 595.00 |
D4275 | NON-AUTOGENOUS CONNECTIVE TISSUE GRAFT (INCLUDING RECIPIENT SITE AND DONOR MATERIAL) FIRST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT | 1200.00 |
D4276 | COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT, PER TOOTH | 1178.15 |
D4277 | FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING RECIPIENT AND DONOR SURGICAL SITES) FIRST TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN GRAFT | 999.00 |
D4278 | FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING RECIPIENT AND DONOR SURGICAL SITES) EACH ADDITIONAL CONTIGUOUS TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN SAME GRAFT SITE | 625.00 |
D4283 | AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE (INCLUDING DONOR AND RECIPIENT SURGICAL SITES) -EACH ADDITIONAL CONTIGUOUS TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN SAME GRAFT SITE | 806.00 |
D4285 | 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 | 400.00 |
D4320 | PROVISIONAL SPLINTING - INTRACORONAL | 546.00 |
D4321 | PROVISIONAL SPLINTING - EXTRACORONAL | 327.00 |
D4341 | PERIODONTAL SCALING AND ROOT PLANING - FOUR OR MORE TEETH PER QUADRANT | 245.00 |
D4342 | PERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH PER QUADRANT | 178.00 |
D4346 | SCALING IN PRESENCE OF GENERALIZED MODERATE OR SEVERE GINGIVAL INFLAMMATION - FULL MOUTH, AFTER ORAL EVALUATION | 150.00 |
D4355 | FULL MOUTH DEBRIDEMENT TO ENABLE A COMPREHENSIVE ORAL EVALUATION AND DIAGNOSIS ON A SUBSEQUENT VISIT | 165.00 |
D4381 | LOCALIZED DELIVERY OF ANTIMICROBIAL AGENTS VIA A CONTROLLED RELEASE VEHICLE INTO DISEASED CREVICULAR TISSUE, PER TOOTH | 78.00 |
D4910 | PERIODONTAL MAINTENANCE | 138.00 |
D4920 | UNSCHEDULED DRESSING CHANGE (BY SOMEONE OTHER THAN TREATING DENTIST OR THEIR STAFF) | 108.26 |
D4921 | GINGIVAL IRRIGATION - PER QUADRANT | 17.00 |
D4999 | UNSPECIFIED PERIODONTAL PROCEDURE, BY REPORT | BR |
D5110 | COMPLETE DENTURE - MAXILLARY | 1325.00 |
D5120 | COMPLETE DENTURE - MANDIBULAR | 1295.00 |
D5130 | IMMEDIATE DENTURE - MAXILLARY | 1470.01 |
D5140 | IMMEDIATE DENTURE - MANDIBULAR | 1402.00 |
D5211 | MAXILLARY PARTIAL DENTURE - RESIN BASE (INCLUDING, RETENTIVE/CLASPING MATERIALS, RESTS, AND TEETH) | 950.00 |
D5212 | MANDIBULAR PARTIAL DENTURE - RESIN BASE (INCLUDING, RETENTIVE/CLASPING MATERIALS, RESTS, AND TEETH) | 1095.00 |
D5213 | MAXILLARY PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH) | 1485.00 |
D5214 | MANDIBULAR PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH) | 1500.01 |
D5221 | IMMEDIATE MAXILLARY PARTIAL DENTURE - RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH) | 909.00 |
D5222 | IMMEDIATE MANDIBULAR PARTIAL DENTURE - RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH) | 909.00 |
D5223 | IMMEDIATE MAXILLARY PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH) | 1200.00 |
D5224 | IMMEDIATE MANDIBULAR PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH) | 1300.00 |
D5225 | MAXILLARY PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING ANY CLASPS, RESTS AND TEETH) | 1275.00 |
D5226 | MANDIBULAR PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING ANY CLASPS, RESTS AND TEETH) | 1400.00 |
D5282 | REMOVABLE UNILATERAL PARTIAL DENTURE - ONE PIECE CAST METAL (INCLUDING CLASPS AND TEETH), MAXILLARY | 889.56 |
D5283 | REMOVABLE UNILATERAL PARTIAL DENTURE - ONE PIECE CAST METAL (INCLUDING CLASPS AND TEETH), MANDIBULAR | 889.56 |
D5410 | ADJUST COMPLETE DENTURE - MAXILLARY | 88.00 |
D5411 | ADJUST COMPLETE DENTURE - MANDIBULAR | 88.00 |
D5421 | ADJUST PARTIAL DENTURE - MAXILLARY | 80.00 |
D5422 | ADJUST PARTIAL DENTURE - MANDIBULAR | 82.00 |
D5511 | REPAIR BROKEN COMPLETE DENTURE BASE, MANDIBULAR | 155.00 |
D5512 | REPAIR BROKEN COMPLETE DENTURE BASE, MAXILLARY | 155.00 |
D5520 | REPLACE MISSING OR BROKEN TEETH - COMPLETE DENTURE (EACH TOOTH) | 155.00 |
D5611 | REPAIR RESIN PARTIAL DENTURE BASE, MANDIBULAR | 189.00 |
D5612 | REPAIR RESIN PARTIAL DENTURE BASE, MAXILLARY | 160.00 |
D5621 | REPAIR CAST PARTIAL FRAMEWORK, MANDIBULAR | 176.40 |
D5622 | REPAIR CAST PARTIAL FRAMEWORK, MAXILLARY | 176.40 |
D5630 | REPAIR OR REPLACE BROKEN RETENTIVE CLASPING MATERIALS - PER TOOTH | 225.00 |
D5640 | REPLACE BROKEN TEETH - PER TOOTH | 167.00 |
D5650 | ADD TOOTH TO EXISTING PARTIAL DENTURE | 197.00 |
D5660 | ADD CLASP TO EXISTING PARTIAL DENTURE - PER TOOTH | 220.00 |
D5670 | REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MAXILLARY) | 554.40 |
D5671 | REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MANDIBULAR) | 554.40 |
D5710 | REBASE COMPLETE MAXILLARY DENTURE | 550.00 |
D5711 | REBASE COMPLETE MANDIBULAR DENTURE | 400.00 |
D5720 | REBASE MAXILLARY PARTIAL DENTURE | 529.20 |
D5721 | REBASE MANDIBULAR PARTIAL DENTURE | 493.00 |
D5730 | RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE) | 308.00 |
D5731 | RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) | 308.00 |
D5740 | RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE) | 295.00 |
D5741 | RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE) | 285.00 |
D5750 | RELINE COMPLETE MAXILLARY DENTURE (LABORATORY) | 432.00 |
D5751 | RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY) | 439.00 |
D5760 | RELINE MAXILLARY PARTIAL DENTURE (LABORATORY) | 426.00 |
D5761 | RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY) | 386.00 |
D5810 | INTERIM COMPLETE DENTURE (MAXILLARY) | 750.00 |
D5811 | INTERIM COMPLETE DENTURE (MANDIBULAR) | 718.20 |
D5820 | INTERIM PARTIAL DENTURE (MAXILLARY) | 590.00 |
D5821 | INTERIM PARTIAL DENTURE (MANDIBULAR) | 550.00 |
D5850 | TISSUE CONDITIONING, MAXILLARY | 145.00 |
D5851 | TISSUE CONDITIONING, MANDIBULAR | 130.00 |
D5862 | PRECISION ATTACHMENT, BY REPORT | BR |
D5863 | OVERDENTURE - COMPLETE MAXILLARY | 1461.60 |
D5864 | OVERDENTURE - PARTIAL MAXILLARY | 1927.80 |
D5865 | OVERDENTURE - COMPLETE MANDIBULAR | 1461.60 |
D5866 | OVERDENTURE - PARTIAL MANDIBULAR | 2003.40 |
D5867 | REPLACEMENT OF REPLACEABLE PART OF SEMI-PRECISION OR PRECISION ATTACHMENT (MALE OR FEMALE COMPONENT) | 175.00 |
D5875 | MODIFICATION OF REMOVABLE PROSTHESIS FOLLOWING IMPLANT SURGERY | BR |
D5876 | ADD METAL SUBSTRUCTURE TO ACRYLIC FULL DENTURE (PER ARCH) | BR |
D5899 | UNSPECIFIED REMOVABLE PROSTHODONTIC PROCEDURE, BY REPORT | BR |
D5911 | FACIAL MOULAGE (SECTIONAL) | 258.01 |
D5912 | FACIAL MOULAGE (COMPLETE) | 258.01 |
D5913 | NASAL PROSTHESIS | 5433.04 |
D5914 | AURICULAR PROSTHESIS | 5433.04 |
D5915 | ORBITAL PROSTHESIS | 7352.33 |
D5916 | OCULAR PROSTHESIS | 1961.05 |
D5919 | FACIAL PROSTHESIS | BR |
D5922 | NASAL SEPTAL PROSTHESIS | BR |
D5923 | OCULAR PROSTHESIS, INTERIM | BR |
D5924 | CRANIAL PROSTHESIS | BR |
D5925 | FACIAL AUGMENTATION IMPLANT PROSTHESIS | BR |
D5926 | NASAL PROSTHESIS, REPLACEMENT | BR |
D5927 | AURICULAR PROSTHESIS, REPLACEMENT | BR |
D5928 | ORBITAL PROSTHESIS, REPLACEMENT | BR |
D5929 | FACIAL PROSTHESIS, REPLACEMENT | BR |
D5931 | OBTURATOR PROSTHESIS, SURGICAL | 2925.34 |
D5932 | OBTURATOR PROSTHESIS, DEFINITIVE | 5471.09 |
D5933 | OBTURATOR PROSTHESIS, MODIFICATION | BR |
D5934 | MANDIBULAR RESECTION PROSTHESIS WITH GUIDE FLANGE | 4986.63 |
D5935 | MANDIBULAR RESECTION PROSTHESIS WITHOUT GUIDE FLANGE | 4338.82 |
D5936 | OBTURATOR PROSTHESIS, INTERIM | 4873.40 |
D5937 | TRISMUS APPLIANCE (NOT FOR TMD TREATMENT) | 612.54 |
D5951 | FEEDING AID | 796.30 |
D5952 | SPEECH AID PROSTHESIS, PEDIATRIC | 2585.66 |
D5953 | SPEECH AID PROSTHESIS, ADULT | 4910.52 |
D5954 | PALATAL AUGMENTATION PROSTHESIS | 4550.43 |
D5955 | PALATAL LIFT PROSTHESIS, DEFINITIVE | 4208.89 |
D5958 | PALATAL LIFT PROSTHESIS, INTERIM | BR |
D5959 | PALATAL LIFT PROSTHESIS, MODIFICATION | BR |
D5960 | SPEECH AID PROSTHESIS, MODIFICATION | BR |
D5982 | SURGICAL STENT | 413.00 |
D5983 | RADIATION CARRIER | 928.09 |
D5984 | RADIATION SHIELD | 928.09 |
D5985 | RADIATION CONE LOCATOR | 928.09 |
D5986 | FLUORIDE GEL CARRIER | 45.00 |
D5987 | COMMISSURE SPLINT | 1392.14 |
D5988 | SURGICAL SPLINT | 278.43 |
D5991 | VESICULOBULLOUS DISEASE MEDICAMENT CARRIER | 106.73 |
D5992 | ADJUST MAXILLOFACIAL PROSTHETIC APPLIANCE, BY REPORT | BR |
D5993 | MAINTENANCE AND CLEANING OF A MAXILLOFACIAL PROSTHESIS (EXTRA- OR INTRA-ORAL) OTHER THAN REQUIRED ADJUSTMENTS, BY REPORT | BR |
D5994 | PERIODONTAL MEDICAMENT CARRIER WITH PERIPHERAL SEAL - LABORATORY PROCESSED | 700.00 |
D5999 | UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT | BR |
D6010 | SURGICAL PLACEMENT OF IMPLANT BODY: ENDOSTEAL IMPLANT | 1899.99 |
D6011 | SECOND STAGE IMPLANT SURGERY | 190.00 |
D6012 | SURGICAL PLACEMENT OF INTERIM IMPLANT BODY FOR TRANSITIONAL PROSTHESIS: ENDOSTEAL IMPLANT | 2175.39 |
D6013 | SURGICAL PLACEMENT OF MINI IMPLANT | 1200.00 |
D6040 | SURGICAL PLACEMENT: EPOSTEAL IMPLANT | 7921.94 |
D6050 | SURGICAL PLACEMENT: TRANSOSTEAL IMPLANT | 5910.02 |
D6051 | INTERIM ABUTMENT | 80.00 |
D6052 | SEMI-PRECISION ATTACHMENT ABUTMENT | 695.00 |
D6055 | CONNECTING BAR - IMPLANT SUPPORTED OR ABUTMENT SUPPORTED | 691.60 |
D6056 | PREFABRICATED ABUTMENT - INCLUDES MODIFICATION AND PLACEMENT | 555.00 |
D6057 | CUSTOM FABRICATED ABUTMENT - INCLUDES PLACEMENT | 750.00 |
D6058 | ABUTMENT SUPPORTED PORCELAIN/CERAMIC CROWN | 1280.00 |
D6059 | ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (HIGH NOBLE METAL) | 1292.00 |
D6060 | ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (PREDOMINANTLY BASE METAL) | 1290.00 |
D6061 | ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (NOBLE METAL) | 1281.00 |
D6062 | ABUTMENT SUPPORTED CAST METAL CROWN (HIGH NOBLE METAL) | 1013.00 |
D6063 | ABUTMENT SUPPORTED CAST METAL CROWN (PREDOMINANTLY BASE METAL) | 1093.98 |
D6064 | ABUTMENT SUPPORTED CAST METAL CROWN (NOBLE METAL) | 1223.00 |
D6065 | IMPLANT SUPPORTED PORCELAIN/CERAMIC CROWN | 1400.00 |
D6066 | IMPLANT SUPPORTED PORCELAIN FUSED TO METAL CROWN (TITANIUM, TITANIUM ALLOY, HIGH NOBLE METAL) | 1450.00 |
D6067 | IMPLANT SUPPORTED METAL CROWN (TITANIUM, TITANIUM ALLOY, HIGH NOBLE METAL) | 1232.30 |
D6068 | ABUTMENT SUPPORTED RETAINER FOR PORCELAIN/CERAMIC FPD | 1307.00 |
D6069 | ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (HIGH NOBLE METAL) | 962.00 |
D6070 | ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (PREDOMINANTLY BASE METAL) | 1236.07 |
D6071 | ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (NOBLE METAL) | 1550.00 |
D6072 | ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (HIGH NOBLE METAL) | 1276.31 |
D6073 | ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (PREDOMINANTLY BASE METAL) | 1165.66 |
D6074 | ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (NOBLE METAL) | 1238.59 |
D6075 | IMPLANT SUPPORTED RETAINER FOR CERAMIC FPD | 1329.00 |
D6076 | IMPLANT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (TITANIUM, TITANIUM ALLOY, OR HIGH NOBLE METAL) | 1800.00 |
D6077 | IMPLANT SUPPORTED RETAINER FOR CAST METAL FPD (TITANIUM, TITANIUM ALLOY, OR HIGH NOBLE METAL) | 1232.30 |
D6080 | IMPLANT MAINTENANCE PROCEDURES WHEN PROSTHESES ARE REMOVED AND REINSERTED, INCLUDING CLEANSING OF PROSTHESES AND ABUTMENTS | 158.00 |
D6081 | 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 | 55.33 |
D6085 | PROVISIONAL IMPLANT CROWN | 379.75 |
D6090 | REPAIR IMPLANT SUPPORTED PROSTHESIS, BY REPORT | BR |
D6091 | REPLACEMENT OF SEMI-PRECISION OR PRECISION ATTACHMENT (MALE OR FEMALE COMPONENT) OF IMPLANT/ABUTMENT SUPPORTED PROSTHESIS, PER ATTACHMENT | 95.00 |
D6092 | RE-CEMENT OR RE-BOND IMPLANT/ABUTMENT SUPPORTED CROWN | 137.00 |
D6093 | RE-CEMENT OR RE-BOND IMPLANT/ABUTMENT SUPPORTED FIXED PARTIAL DENTURE | 159.70 |
D6094 | ABUTMENT SUPPORTED CROWN - (TITANIUM) | 1037.40 |
D6095 | REPAIR IMPLANT ABUTMENT, BY REPORT | BR |
D6096 | REMOVE BROKEN IMPLANT RETAINING SCREW | BR |
D6100 | IMPLANT REMOVAL, BY REPORT | BR |
D6101 | DEBRIDEMENT OF A PERI-IMPLANT DEFECT OR DEFECTS SURROUNDING A SINGLE IMPLANT, AND SURFACE CLEANING OF THE EXPOSED IMPLANT SURFACES, INCLUDING FLAP ENTRY AND CLOSURE | 373.46 |
D6102 | DEBRIDEMENT AND OSSEOUS CONTOURING OF A PERI-IMPLANT DEFECT OR DEFECTS SURROUNDING A SINGLE IMPLANT AND INCLUDES SURFACE CLEANING OF THE EXPOSED IMPLANT SURFACES, INCLUDING FLAP ENTRY AND CLOSURE | 513.04 |
D6103 | BONE GRAFT FOR REPAIR OF PERI-IMPLANT DEFECT - DOES NOT INCLUDE FLAP ENTRY AND CLOSURE | 427.53 |
D6104 | BONE GRAFT AT TIME OF IMPLANT PLACEMENT | 400.00 |
D6110 | IMPLANT /ABUTMENT SUPPORTED REMOVABLE DENTURE FOR EDENTULOUS ARCH - MAXILLARY | 2993.01 |
D6111 | IMPLANT /ABUTMENT SUPPORTED REMOVABLE DENTURE FOR EDENTULOUS ARCH - MANDIBULAR | 3000.00 |
D6112 | IMPLANT /ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH - MAXILLARY | 1718.93 |
D6113 | IMPLANT /ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH - MANDIBULAR | 1718.93 |
D6114 | IMPLANT /ABUTMENT SUPPORTED FIXED DENTURE FOR EDENTULOUS ARCH - MAXILLARY | 3010.34 |
D6115 | IMPLANT /ABUTMENT SUPPORTED FIXED DENTURE FOR EDENTULOUS ARCH - MANDIBULAR | 3010.34 |
D6116 | IMPLANT /ABUTMENT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENTULOUS ARCH - MAXILLARY | 2308.68 |
D6117 | IMPLANT /ABUTMENT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENTULOUS ARCH - MANDIBULAR | 2308.68 |
D6118 | IMPLANT/ABUTMENT SUPPORTED INTERIM FIXED DENTURE FOR EDENTULOUS ARCH - MANDIBULAR | 1565.53 |
D6119 | IMPLANT/ABUTMENT SUPPORTED INTERIM FIXED DENTURE FOR EDENTULOUS ARCH - MAXILLARY | 1565.53 |
D6190 | RADIOGRAPHIC/SURGICAL IMPLANT INDEX, BY REPORT | BR |
D6194 | ABUTMENT SUPPORTED RETAINER CROWN FOR FPD (TITANIUM) | 1068.83 |
D6199 | UNSPECIFIED IMPLANT PROCEDURE, BY REPORT | BR |
D6205 | PONTIC - INDIRECT RESIN BASED COMPOSITE | 638.77 |
D6210 | PONTIC - CAST HIGH NOBLE METAL | 1090.00 |
D6211 | PONTIC - CAST PREDOMINANTLY BASE METAL | 915.16 |
D6212 | PONTIC - CAST NOBLE METAL | 952.01 |
D6214 | PONTIC - TITANIUM | 982.72 |
D6240 | PONTIC - PORCELAIN FUSED TO HIGH NOBLE METAL | 994.00 |
D6241 | PONTIC - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL | 924.00 |
D6242 | PONTIC - PORCELAIN FUSED TO NOBLE METAL | 1000.00 |
D6245 | PONTIC - PORCELAIN/CERAMIC | 1090.00 |
D6250 | PONTIC - RESIN WITH HIGH NOBLE METAL | 952.01 |
D6251 | PONTIC - RESIN WITH PREDOMINANTLY BASE METAL | 925.00 |
D6252 | PONTIC - RESIN WITH NOBLE METAL | 950.00 |
D6253 | PROVISIONAL PONTIC - FURTHER TREATMENT OR COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO FINAL IMPRESSION | 410.29 |
D6545 | RETAINER - CAST METAL FOR RESIN BONDED FIXED PROSTHESIS | 732.00 |
D6548 | RETAINER - PORCELAIN/CERAMIC FOR RESIN BONDED FIXED PROSTHESIS | 990.00 |
D6549 | RETAINER - FOR RESIN BONDED FIXED PROSTHESIS | 292.36 |
D6600 | RETAINER INLAY - PORCELAIN/CERAMIC, TWO SURFACES | 804.60 |
D6601 | RETAINER INLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES | 843.91 |
D6602 | RETAINER INLAY - CAST HIGH NOBLE METAL, TWO SURFACES | 859.88 |
D6603 | RETAINER INLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES | 945.87 |
D6604 | RETAINER INLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES | 842.68 |
D6605 | RETAINER INLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES | 893.05 |
D6606 | RETAINER INLAY - CAST NOBLE METAL, TWO SURFACES | 829.17 |
D6607 | RETAINER INLAY - CAST NOBLE METAL, THREE OR MORE SURFACES | 920.07 |
D6608 | RETAINER ONLAY - PORCELAIN/CERAMIC, TWO SURFACES | 874.62 |
D6609 | RETAINER ONLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES | 912.70 |
D6610 | RETAINER ONLAY - CAST HIGH NOBLE METAL, TWO SURFACES | 927.44 |
D6611 | RETAINER ONLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES | 1014.66 |
D6612 | RETAINER ONLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES | 922.53 |
D6613 | RETAINER ONLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES | 964.29 |
D6614 | RETAINER ONLAY - CAST NOBLE METAL, TWO SURFACES | 902.87 |
D6615 | RETAINER ONLAY - CAST NOBLE METAL, THREE OR MORE SURFACES | 938.50 |
D6624 | RETAINER INLAY - TITANIUM | 859.88 |
D6634 | RETAINER ONLAY - TITANIUM | 902.87 |
D6710 | RETAINER CROWN - INDIRECT RESIN BASED COMPOSITE | 115.00 |
D6720 | RETAINER CROWN - RESIN WITH HIGH NOBLE METAL | 956.00 |
D6721 | RETAINER CROWN - RESIN WITH PREDOMINANTLY BASE METAL | 1019.57 |
D6722 | RETAINER CROWN - RESIN WITH NOBLE METAL | 1302.00 |
D6740 | RETAINER CROWN - PORCELAIN/CERAMIC | 1088.00 |
D6750 | RETAINER CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL | 998.00 |
D6751 | RETAINER CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL | 945.00 |
D6752 | RETAINER CROWN - PORCELAIN FUSED TO NOBLE METAL | 1000.00 |
D6780 | RETAINER CROWN - 3/4 CAST HIGH NOBLE METAL | 1038.00 |
D6781 | RETAINER CROWN - 3/4 CAST PREDOMINANTLY BASE METAL | 1038.00 |
D6782 | RETAINER CROWN - 3/4 CAST NOBLE METAL | 964.29 |
D6783 | RETAINER CROWN - 3/4 PORCELAIN/CERAMIC | 1068.71 |
D6790 | RETAINER CROWN - FULL CAST HIGH NOBLE METAL | 1300.00 |
D6791 | RETAINER CROWN - FULL CAST PREDOMINANTLY BASE METAL | 1007.29 |
D6792 | RETAINER CROWN - FULL CAST NOBLE METAL | 1044.14 |
D6793 | PROVISIONAL RETAINER CROWN - FURTHER TREATMENT OR COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO FINAL IMPRESSION | 478.00 |
D6794 | RETAINER CROWN - TITANIUM | 1044.14 |
D6920 | CONNECTOR BAR | 221.11 |
D6930 | RE-CEMENT OR RE-BOND FIXED PARTIAL DENTURE | 141.00 |
D6940 | STRESS BREAKER | 292.36 |
D6950 | PRECISION ATTACHMENT | 559.00 |
D6980 | FIXED PARTIAL DENTURE REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE | 249.00 |
D6985 | PEDIATRIC PARTIAL DENTURE, FIXED | 491.36 |
D6999 | UNSPECIFIED FIXED PROSTHODONTIC PROCEDURE, BY REPORT | BR |
D7111 | EXTRACTION, CORONAL REMNANTS - PRIMARY TOOTH | 111.00 |
D7140 | EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL) | 160.00 |
D7210 | EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED | 250.00 |
D7220 | REMOVAL OF IMPACTED TOOTH - SOFT TISSUE | 315.00 |
D7230 | REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY | 400.00 |
D7240 | REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY | 460.00 |
D7241 | REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY, WITH UNUSUAL SURGICAL COMPLICATIONS | 500.00 |
D7250 | REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE) | 255.00 |
D7251 | CORONECTOMY - INTENTIONAL PARTIAL TOOTH REMOVAL | 450.00 |
D7260 | OROANTRAL FISTULA CLOSURE | 1618.34 |
D7261 | PRIMARY CLOSURE OF A SINUS PERFORATION | 674.31 |
D7270 | TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED TOOTH | 498.00 |
D7272 | TOOTH TRANSPLANTATION (INCLUDES REIMPLANTATION FROM ONE SITE TO ANOTHER AND SPLINTING AND/OR STABILIZATION) | 674.31 |
D7280 | EXPOSURE OF AN UNERUPTED TOOTH | 555.00 |
D7282 | MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION | 200.00 |
D7283 | PLACEMENT OF DEVICE TO FACILITATE ERUPTION OF IMPACTED TOOTH | 255.00 |
D7285 | INCISIONAL BIOPSY OF ORAL TISSUE-HARD (BONE, TOOTH) | 900.00 |
D7286 | INCISIONAL BIOPSY OF ORAL TISSUE-SOFT | 399.00 |
D7287 | EXFOLIATIVE CYTOLOGICAL SAMPLE COLLECTION | 161.83 |
D7288 | BRUSH BIOPSY - TRANSEPITHELIAL SAMPLE COLLECTION | 161.83 |
D7290 | SURGICAL REPOSITIONING OF TEETH | 404.59 |
D7291 | TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, BY REPORT | BR |
D7292 | PLACEMENT OF TEMPORARY ANCHORAGE DEVICE [SCREW RETAINED PLATE] REQUIRING FLAP; INCLUDES DEVICE REMOVAL | 647.34 |
D7293 | PLACEMENT OF TEMPORARY ANCHORAGE DEVICE REQUIRING FLAP; INCLUDES DEVICE REMOVAL | 404.59 |
D7294 | PLACEMENT OF TEMPORARY ANCHORAGE DEVICE WITHOUT FLAP; INCLUDES DEVICE REMOVAL | 337.16 |
D7295 | HARVEST OF BONE FOR USE IN AUTOGENOUS GRAFTING PROCEDURE | BR |
D7296 | CORTICOTOMY - ONE TO THREE TEETH OR TOOTH SPACES, PER QUADRANT | BR |
D7297 | CORTICOTOMY - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT | BR |
D7310 | ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT | 220.00 |
D7311 | ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH SPACES, PER QUADRANT | 175.00 |
D7320 | ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT | 368.00 |
D7321 | ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH SPACES, PER QUADRANT | 327.00 |
D7340 | VESTIBULOPLASTY - RIDGE EXTENSION (SECONDARY EPITHELIALIZATION) | 1854.35 |
D7350 | VESTIBULOPLASTY - RIDGE EXTENSION (INCLUDING SOFT TISSUE GRAFTS, MUSCLE REATTACHMENT, REVISION OF SOFT TISSUE ATTACHMENT AND MANAGEMENT OF HYPERTROPHIED AND HYPERPLASTIC TISSUE) | 5394.48 |
D7410 | EXCISION OF BENIGN LESION UP TO 1.25 CM | 425.00 |
D7411 | EXCISION OF BENIGN LESION GREATER THAN 1.25 CM | 650.00 |
D7412 | EXCISION OF BENIGN LESION, COMPLICATED | 1416.05 |
D7413 | EXCISION OF MALIGNANT LESION UP TO 1.25 CM | 944.03 |
D7414 | EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM | 1416.05 |
D7415 | EXCISION OF MALIGNANT LESION, COMPLICATED | 1584.63 |
D7440 | EXCISION OF MALIGNANT TUMOR - LESION DIAMETER UP TO 1.25 CM | 1281.19 |
D7441 | EXCISION OF MALIGNANT TUMOR - LESION DIAMETER GREATER THAN 1.25 CM | 1888.07 |
D7450 | REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM | 990.00 |
D7451 | REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN 1.25 CM | 975.00 |
D7460 | REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM | 809.17 |
D7461 | REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN 1.25 CM | 1105.87 |
D7465 | DESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL METHOD, BY REPORT | BR |
D7471 | REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE) | 650.00 |
D7472 | REMOVAL OF TORUS PALATINUS | 1190.83 |
D7473 | REMOVAL OF TORUS MANDIBULARIS | 695.00 |
D7485 | REDUCTION OF OSSEOUS TUBEROSITY | 425.00 |
D7490 | RADICAL RESECTION OF MAXILLA OR MANDIBLE | 8091.72 |
D7510 | INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE | 220.00 |
D7511 | INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE - COMPLICATED (INCLUDES DRAINAGE OF MULTIPLE FASCIAL SPACES) | 295.00 |
D7520 | INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE | 1380.99 |
D7521 | INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE - COMPLICATED (INCLUDES DRAINAGE OF MULTIPLE FASCIAL SPACES) | 1517.20 |
D7530 | REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE | 497.64 |
D7540 | REMOVAL OF REACTION PRODUCING FOREIGN BODIES, MUSCULOSKELETAL SYSTEM | 551.59 |
D7550 | PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE | 950.00 |
D7560 | MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT OR FOREIGN BODY | 2730.96 |
D7610 | MAXILLA - OPEN REDUCTION (TEETH IMMOBILIZED, IF PRESENT) | 4416.73 |
D7620 | MAXILLA - CLOSED REDUCTION (TEETH IMMOBILIZED, IF PRESENT) | 3312.21 |
D7630 | MANDIBLE - OPEN REDUCTION (TEETH IMMOBILIZED, IF PRESENT) | 5742.42 |
D7640 | MANDIBLE - CLOSED REDUCTION (TEETH IMMOBILIZED, IF PRESENT) | 3643.97 |
D7650 | MALAR AND/OR ZYGOMATIC ARCH - OPEN REDUCTION | 2760.63 |
D7660 | MALAR AND/OR ZYGOMATIC ARCH - CLOSED REDUCTION | 1627.78 |
D7670 | ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH | 1270.40 |
D7671 | ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH | 2393.80 |
D7680 | FACIAL BONES - COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL APPROACHES | 8281.88 |
D7710 | MAXILLA - OPEN REDUCTION | 5190.84 |
D7720 | MAXILLA - CLOSED REDUCTION | 3643.97 |
D7730 | MANDIBLE - OPEN REDUCTION | 7509.12 |
D7740 | MANDIBLE - CLOSED REDUCTION | 3715.45 |
D7750 | MALAR AND/OR ZYGOMATIC ARCH - OPEN REDUCTION | 4725.56 |
D7760 | MALAR AND/OR ZYGOMATIC ARCH - CLOSED REDUCTION | 1896.16 |
D7770 | ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH | 2569.12 |
D7771 | ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH | 1982.47 |
D7780 | FACIAL BONES - COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE APPROACHES | 11042.50 |
D7810 | OPEN REDUCTION OF DISLOCATION | 4857.73 |
D7820 | CLOSED REDUCTION OF DISLOCATION | 795.69 |
D7830 | MANIPULATION UNDER ANESTHESIA | 455.83 |
D7840 | CONDYLECTOMY | 6621.72 |
D7850 | SURGICAL DISCECTOMY, WITH/WITHOUT IMPLANT | 5718.15 |
D7852 | DISC REPAIR | 6547.55 |
D7854 | SYNOVECTOMY | 6756.59 |
D7856 | MYOTOMY | 4794.34 |
D7858 | JOINT RECONSTRUCTION | 13665.57 |
D7860 | ARTHROTOMY | 5824.69 |
D7865 | ARTHROPLASTY | 9386.40 |
D7870 | ARTHROCENTESIS | 310.18 |
D7871 | NON-ARTHROSCOPIC LYSIS AND LAVAGE | 620.37 |
D7872 | ARTHROSCOPY - DIAGNOSIS, WITH OR WITHOUT BIOPSY | 3310.86 |
D7873 | ARTHROSCOPY: LAVAGE AND LYSIS OF ADHESIONS | 3986.52 |
D7874 | ARTHROSCOPY: DISC REPOSITIONING AND STABILIZATION | 5718.15 |
D7875 | ARTHROSCOPY: SYNOVECTOMY | 6264.34 |
D7876 | ARTHROSCOPY: DISCECTOMY | 6753.89 |
D7877 | ARTHROSCOPY: DEBRIDEMENT | 5960.90 |
D7880 | OCCLUSAL ORTHOTIC DEVICE, BY REPORT | BR |
D7881 | OCCLUSAL ORTHOTIC DEVICE ADJUSTMENT | 80.92 |
D7899 | UNSPECIFIED TMD THERAPY, BY REPORT | BR |
D7910 | SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM | 80.00 |
D7911 | COMPLICATED SUTURE - UP TO 5 CM | 1104.52 |
D7912 | COMPLICATED SUTURE - GREATER THAN 5 CM | 1987.87 |
D7920 | SKIN GRAFT (IDENTIFY DEFECT COVERED, LOCATION AND TYPE OF GRAFT) | 3256.92 |
D7921 | COLLECTION AND APPLICATION OF AUTOLOGOUS BLOOD CONCENTRATE PRODUCT | 299.00 |
D7940 | OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES | BR |
D7941 | OSTEOTOMY - MANDIBULAR RAMI | 8294.01 |
D7943 | OSTEOTOMY - MANDIBULAR RAMI WITH BONE GRAFT; INCLUDES OBTAINING THE GRAFT | 7619.70 |
D7944 | OSTEOTOMY - SEGMENTED OR SUBAPICAL | 6790.30 |
D7945 | OSTEOTOMY - BODY OF MANDIBLE | 9035.75 |
D7946 | LEFORT I (MAXILLA - TOTAL) | 11193.55 |
D7947 | LEFORT I (MAXILLA - SEGMENTED) | 9413.37 |
D7948 | LEFORT II OR LEFORT III (OSTEOPLASTY OF FACIAL BONES FOR MIDFACE HYPOPLASIA OR RETRUSION) - WITHOUT BONE GRAFT | 12218.50 |
D7949 | LEFORT II OR LEFORT III - WITH BONE GRAFT | 15913.72 |
D7950 | OSSEOUS, OSTEOPERIOSTEAL, OR CARTILAGE GRAFT OF THE MANDIBLE OR MAXILLA - AUTOGENOUS OR NONAUTOGENOUS, BY REPORT | BR |
D7951 | SINUS AUGMENTATION WITH BONE OR BONE SUBSTITUTES VIA A LATERAL OPEN APPROACH | 1600.00 |
D7952 | SINUS AUGMENTATION VIA A VERTICAL APPROACH | 850.00 |
D7953 | BONE REPLACEMENT GRAFT FOR RIDGE PRESERVATION - PER SITE | 400.00 |
D7955 | REPAIR OF MAXILLOFACIAL SOFT AND/OR HARD TISSUE DEFECT | BR |
D7960 | FRENULECTOMY - ALSO KNOWN AS FRENECTOMY OR FRENOTOMY - SEPARATE PROCEDURE NOT INCIDENTAL TO ANOTHER PROCEDURE | 450.00 |
D7963 | FRENULOPLASTY | 606.88 |
D7970 | EXCISION OF HYPERPLASTIC TISSUE - PER ARCH | 197.00 |
D7971 | EXCISION OF PERICORONAL GINGIVA | 226.00 |
D7972 | SURGICAL REDUCTION OF FIBROUS TUBEROSITY | 305.00 |
D7979 | NON - SURGICAL SIALOLITHOTOMY | BR |
D7980 | SURGICAL SIALOLITHOTOMY | 332.00 |
D7981 | EXCISION OF SALIVARY GLAND, BY REPORT | BR |
D7982 | SIALODOCHOPLASTY | 2009.44 |
D7983 | CLOSURE OF SALIVARY FISTULA | 1928.53 |
D7990 | EMERGENCY TRACHEOTOMY | 1658.80 |
D7991 | CORONOIDECTOMY | 4045.86 |
D7995 | SYNTHETIC GRAFT - MANDIBLE OR FACIAL BONES, BY REPORT | BR |
D7996 | IMPLANT-MANDIBLE FOR AUGMENTATION PURPOSES (EXCLUDING ALVEOLAR RIDGE), BY REPORT | BR |
D7997 | APPLIANCE REMOVAL (NOT BY DENTIST WHO PLACED APPLIANCE), INCLUDES REMOVAL OF ARCHBAR | 310.18 |
D7998 | INTRAORAL PLACEMENT OF A FIXATION DEVICE NOT IN CONJUNCTION WITH A FRACTURE | 1348.62 |
D7999 | UNSPECIFIED ORAL SURGERY PROCEDURE, BY REPORT | BR |
D8010 | LIMITED ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION | BR |
D8020 | LIMITED ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION | 174.20 |
D8030 | LIMITED ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION | 230.00 |
D8040 | LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION | 437.50 |
D8050 | INTERCEPTIVE ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION | 136.00 |
D8060 | INTERCEPTIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION | 240.00 |
D8070 | COMPREHENSIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION | 206.00 |
D8080 | COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION | 237.00 |
D8090 | COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION | 245.00 |
D8210 | REMOVABLE APPLIANCE THERAPY | 330.00 |
D8220 | FIXED APPLIANCE THERAPY | 807.00 |
D8660 | PRE-ORTHODONTIC TREATMENT EXAMINATION TO MONITOR GROWTH AND DEVELOPMENT | 210.00 |
D8670 | PERIODIC ORTHODONTIC TREATMENT VISIT | 200.00 |
D8680 | ORTHODONTIC RETENTION (REMOVAL OF APPLIANCES, CONSTRUCTION AND PLACEMENT OF RETAINER(S)) | 340.00 |
D8681 | REMOVABLE ORTHODONTIC RETAINER ADJUSTMENT | 100.00 |
D8690 | ORTHODONTIC TREATMENT (ALTERNATIVE BILLING TO A CONTRACT FEE) | 265.00 |
D8691 | REPAIR OF ORTHODONTIC APPLIANCE | 104.00 |
D8692 | REPLACEMENT OF LOST OR BROKEN RETAINER | 263.00 |
D8693 | RE-CEMENT OR RE-BOND FIXED RETAINER | 100.00 |
D8694 | REPAIR OF FIXED RETAINERS, INCLUDES REATTACHMENT | BR |
D8695 | REMOVAL OF FIXED ORTHODONTIC APPLIANCES FOR REASONS OTHER THAN COMPLETION OF TREATMENT | BR |
D8999 | UNSPECIFIED ORTHODONTIC PROCEDURE, BY REPORT | BR |
D9110 | PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE | 105.00 |
D9120 | FIXED PARTIAL DENTURE SECTIONING | 200.00 |
D9130 | TEMPOROMANDIBULAR JOINT DYSFUNCTION - NON-INVASIVE PHYSICAL THERAPIES | BR |
D9210 | LOCAL ANESTHESIA NOT IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES | 75.00 |
D9211 | REGIONAL BLOCK ANESTHESIA | 42.35 |
D9212 | TRIGEMINAL DIVISION BLOCK ANESTHESIA | 73.00 |
D9215 | LOCAL ANESTHESIA IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES | 56.00 |
D9219 | EVALUATION FOR MODERATE SEDATION, DEEP SEDATION OR GENERAL ANESTHESIA | 75.44 |
D9222 | DEEP SEDATION/GENERAL ANESTHESIA - FIRST 15 MINUTES | 210.00 |
D9223 | DEEP SEDATION/GENERAL ANESTHESIA - EACH SUBSEQUENT 15 MINUTE INCREMENT | 200.00 |
D9230 | INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS | 50.00 |
D9239 | INTRAVENOUS MODERATE (CONSCIOUS) SEDATION/ANALGESIA- FIRST 15 MINUTES | 170.00 |
D9243 | INTRAVENOUS MODERATE (CONSCIOUS) SEDATION/ANALGESIA - EACH SUBSEQUENT 15 MINUTE INCREMENT | 170.00 |
D9248 | NON-INTRAVENOUS CONSCIOUS SEDATION | 195.00 |
D9310 | CONSULTATION - DIAGNOSTIC SERVICE PROVIDED BY DENTIST OR PHYSICIAN OTHER THAN REQUESTING DENTIST OR PHYSICIAN | 112.00 |
D9311 | CONSULTATION WITH A MEDICAL HEALTH CARE PROFESSIONAL | 211.76 |
D9410 | HOUSE/EXTENDED CARE FACILITY CALL | 242.21 |
D9420 | HOSPITAL OR AMBULATORY SURGICAL CENTER CALL | 295.00 |
D9430 | OFFICE VISIT FOR OBSERVATION (DURING REGULARLY SCHEDULED HOURS) - NO OTHER SERVICES PERFORMED | 75.00 |
D9440 | OFFICE VISIT - AFTER REGULARLY SCHEDULED HOURS | 155.00 |
D9450 | CASE PRESENTATION, DETAILED AND EXTENSIVE TREATMENT PLANNING | 45.00 |
D9610 | THERAPEUTIC PARENTERAL DRUG, SINGLE ADMINISTRATION | 30.00 |
D9612 | THERAPEUTIC PARENTERAL DRUGS, TWO OR MORE ADMINISTRATIONS, DIFFERENT MEDICATIONS | 180.00 |
D9613 | INFILTRATION OF SUSTAINED RELEASE THERAPEUTIC DRUG - SINGLE OR MULTIPLE SITES | 38.38 |
D9630 | DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE | 28.00 |
D9910 | APPLICATION OF DESENSITIZING MEDICAMENT | 52.00 |
D9911 | APPLICATION OF DESENSITIZING RESIN FOR CERVICAL AND/OR ROOT SURFACE, PER TOOTH | 25.00 |
D9920 | BEHAVIOR MANAGEMENT, BY REPORT | BR |
D9930 | TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT | BR |
D9932 | CLEANING AND INSPECTION OF REMOVABLE COMPLETE DENTURE, MAXILLARY | 113.82 |
D9933 | CLEANING AND INSPECTION OF REMOVABLE COMPLETE DENTURE, MANDIBULAR | 113.82 |
D9934 | CLEANING AND INSPECTION OF REMOVABLE PARTIAL DENTURE, MAXILLARY | 113.82 |
D9935 | CLEANING AND INSPECTION OF REMOVABLE PARTIAL DENTURE, MANDIBULAR | 113.82 |
D9941 | FABRICATION OF ATHLETIC MOUTHGUARD | 145.00 |
D9942 | REPAIR AND/OR RELINE OF OCCLUSAL GUARD | 79.00 |
D9943 | OCCLUSAL GUARD ADJUSTMENT | 79.41 |
D9944 | OCCLUSAL GUARD - HARD APPLIANCE, FULL ARCH | 383.82 |
D9945 | OCCLUSAL GUARD - SOFT APPLIANCE, FULL ARCH | 383.82 |
D9946 | OCCLUSAL GUARD - HARD APPLIANCE, PARTIAL ARCH | 383.82 |
D9950 | OCCLUSION ANALYSIS - MOUNTED CASE | 350.00 |
D9951 | OCCLUSAL ADJUSTMENT - LIMITED | 135.00 |
D9952 | OCCLUSAL ADJUSTMENT - COMPLETE | 803.00 |
D9961 | DUPLICATE/COPY PATIENT'S RECORDS | BR |
D9970 | ENAMEL MICROABRASION | 156.00 |
D9971 | ODONTOPLASTY 1 - 2 TEETH; INCLUDES REMOVAL OF ENAMEL PROJECTIONS | 115.00 |
D9972 | EXTERNAL BLEACHING - PER ARCH - PERFORMED IN OFFICE | 220.00 |
D9973 | EXTERNAL BLEACHING - PER TOOTH | 50.00 |
D9974 | INTERNAL BLEACHING - PER TOOTH | 273.00 |
D9975 | EXTERNAL BLEACHING FOR HOME APPLICATION, PER ARCH; INCLUDES MATERIALS AND FABRICATION OF CUSTOM TRAYS | 90.00 |
D9985 | SALES TAX | BR |
D9986 | MISSED APPOINTMENT | BR |
D9987 | CANCELLED APPOINTMENT | BR |
D9990 | CERTIFIED TRANSLATION OR SIGN-LANGUAGE SERVICES - PER VISIT | BR |
D9991 | DENTAL CASE MANAGEMENT - ADDRESSING APPOINTMENT COMPLIANCE BARRIERS | 46.32 |
D9992 | DENTAL CASE MANAGEMENT - CARE COORDINATION | 46.32 |
D9993 | DENTAL CASE MANAGEMENT - MOTIVATIONAL INTERVIEWING | 46.32 |
D9994 | DENTAL CASE MANAGEMENT - PATIENT EDUCATION TO IMPROVE ORAL HEALTH LITERACY | 63.53 |
D9995 | TELEDENTISTRY - SYNCHRONOUS; REAL-TIME ENCOUNTER | 211.76 |
D9996 | TELEDENTISTRY - ASYNCHRONOUS; INFORMATION STORED AND FORWARDED TO DENTIST FOR SUBSEQUENT REVIEW | 215.00 |
D9999 | UNSPECIFIED ADJUNCTIVE PROCEDURE, BY REPORT | BR |
20 Miss. Code. R. 2-II