Attachment_2_Dental_Fee_Schedule_29JUN19_(Final).pdf

CDT_Code CDT_Description Base Year Option Year 1 Option Year 2 Option Year 3 6 Months Extension D0120 periodic oral evaluation - established D0140 limited oral evaluation - problem focused D0145 oral evaluation for a patient under three D0150 comprehensive oral evaluation D0160 detailed and extensive oral evaluation - D0170 re-evaluation - limited, problem focused D0171 re-evaluation - post-operative office D0180 comprehensive periodontal evaluation - new D0190 screening of a patient D0191 assessment of a patient D0210 intraoral - complete series of D0220 intraoral - periapical first radiographic D0230 intraoral - periapical each additional D0240 intraoral - occlusal radiographic image D0250 extra-oral - 2D projection radiographic D0251 extra-oral posterior dental radiographic D0270 bitewing - single radiographic image D0272 bitewings - two radiographic images D0273 bitewings - three radiographic images D0274 bitewings - four radiographic images D0277 vertical bitewings - 7 to 8 radiographic D0310 sialography D0320 temporomandibular joint arthrogram, D0321 other temporomandibular joint radiographic D0322 tomographic survey D0330 panoramic radiographic image D0340 2D cephalometric radiographic image - D0350 2D oral/facial photographic image obtained D0351 3D photographic image D0364 cone beam CT capture and interpretation D0365 cone beam CT capture and interpretation D0366 cone beam CT capture and interpretation D0367 cone beam CT capture and interpretation D0368 cone beam CT capture and interpretation D0369 maxillofacial MRI capture and D0370 maxillofacial ultrasound capture and D0371 sialoendoscopy capture and interpretation D0380 cone beam CT image capture with limited D0381 cone beam CT image capture with field of D0382 cone beam CT image capture with field of D0383 cone beam CT image capture with field of D0384 cone beam CT image capture for TMJ series D0385 maxillofacial MRI image capture D0386 maxillofacial ultrasound image capture D0391 interpretation of diagnostic image by a D0393 treatment simulation using 3D image volume D0394 digital subtraction of two or more images D0395 fusion of two or more 3D image volumes of D0411 HbA1c in-office point of service testing D0414 laboratory processing of microbial D0415 collection of microorganisms for culture D0416 viral culture D0417 collection and preparation of saliva D0418 analysis of saliva sample D0422 collection and preparation of genetic D0423 genetic test for susceptibility to D0425 caries susceptibility tests D0431 adjunctive pre-diagnostic test that aids D0460 pulp vitality tests D0470 diagnostic casts D0600 non-ionizing diagnostic procedure capable D0601 caries risk assessment and documentation, D0602 caries risk assessment and documentation, D0603 caries risk assessment and documentation, D0472 accession of tissue, gross examination, D0473 accession of tissue, gross and microscopic D0474 accession of tissue, gross and microscopic D0480 accession of exfoliative cytologic smears, D0486 laboratory accession of transepithelial D0475 decalcification procedure D0476 special stains for microorganisms D0477 special stains, not for microorganisms D0478 immunohistochemical stains D0479 tissue in-situ hybridization, including D0481 electron microscopy D0482 direct immunofluorescence D0483 indirect immunofluorescence D0484 consultation on slides prepared elsewhere D0485 consultation, including preparation of D0502 other oral pathology procedures, by report

FEE SCHEDULE

D0999 unspecified diagnostic procedure, by D1110 prophylaxis - adult D1120 prophylaxis - child D1206 topical application of fluoride varnish D1208 topical application of fluoride - D1310 nutritional counseling for control of D1320 tobacco counseling for the control and D1330 oral hygiene instructions D1351 sealant - per tooth D1353 sealant repair - per tooth D1352 preventive resin restoration in a moderate D1354 interim caries arresting medicament D1510 space maintainer - fixed - unilateral D1515 space maintainer - fixed - bilateral D1520 space maintainer - removable - unilateral D1525 space maintainer - removable - bilateral D1550 re-cement or re-bond space maintainer D1555 removal of fixed space maintainer D1575 distal shoe space maintainer - fixed - D1999 unspecified preventive procedure, by D2140 amalgam - one surface, primary or D2150 amalgam - two surfaces, primary or D2160 amalgam - three surfaces, primary or D2161 amalgam - four or more surfaces, primary D2330 resin-based composite - one surface, D2331 resin-based composite - two surfaces, D2332 resin-based composite - three surfaces, D2335 resin-based composite - four or more D2390 resin-based composite crown, anterior D2391 resin-based composite - one surface, D2392 resin-based composite - two surfaces, D2393 resin-based composite - three surfaces, D2394 resin-based composite - four or more D2410 gold foil - one surface D2420 gold foil - two surfaces D2430 gold foil - three surfaces D2510 inlay - metallic - one surface D2520 inlay - metallic - two surfaces D2530 inlay - metallic - three or more surfaces D2542 onlay - metallic - two surfaces D2543 onlay - metallic - three surfaces D2544 onlay - metallic - four or more surfaces D2610 inlay - porcelain/ceramic - one surface D2620 inlay - porcelain/ceramic - two surfaces D2630 inlay - porcelain/ceramic - three or more D2642 onlay - porcelain/ceramic - two surfaces D2643 onlay - porcelain/ceramic - three surfaces D2644 onlay - porcelain/ceramic - four or more D2650 inlay - resin-based composite - one D2651 inlay - resin-based composite - two D2652 inlay - resin-based composite - three or D2662 onlay - resin-based composite - two D2663 onlay - resin-based composite - three D2664 onlay - resin-based composite - four or D2710 crown - resin-based composite (indirect) D2712 crown - 3/4 resin-based composite D2720 crown - resin with high noble metal D2721 crown - resin with predominantly base D2722 crown - resin with noble metal D2740 crown - porcelain/ceramic D2750 crown - porcelain fused to high noble D2751 crown - porcelain fused to predominantly D2752 crown - porcelain fused to noble metal D2780 crown - 3/4 cast high noble metal D2781 crown - 3/4 cast predominantly base metal D2782 crown - 3/4 cast noble metal D2783 crown - 3/4 porcelain/ceramic D2790 crown - full cast high noble metal D2791 crown - full cast predominantly base metal D2792 crown - full cast noble metal D2794 crown - titanium D2799 provisional crown- further treatment or D2990 resin infiltration of incipient smooth D2910 re-cement or re-bond inlay, onlay, veneer D2915 re-cement or re-bond indirectly fabricated D2920 re-cement or re-bond crown D2921 reattachment of tooth fragment, incisal D2929 prefabricated porcelain/ceramic crown - D2930 prefabricated stainless steel crown - D2931 prefabricated stainless steel crown - D2932 prefabricated resin crown D2933 prefabricated stainless steel crown with D2934 prefabricated esthetic coated stainless

D2940 protective restoration D2941 interim therapeutic restoration - primary D2949 restorative foundation for an indirect D2950 core buildup, including any pins when D2951 pin retention - per tooth, in addition to D2952 post and core in addition to crown, D2953 each additional indirectly fabricated post D2954 prefabricated post and core in addition to D2957 each additional prefabricated post - same D2955 post removal D2960 labial veneer (resin laminate) - chairside D2961 labial veneer (resin laminate) - D2962 labial veneer (porcelain laminate) - D2971 additional procedures to construct new D2975 coping D2980 crown repair necessitated by restorative D2981 inlay repair necessitated by restorative D2982 onlay repair necessitated by restorative D2983 veneer repair necessitated by restorative D2999 unspecified restorative procedure, by D3110 pulp cap - direct (excluding final D3120 pulp cap - indirect (excluding final D3220 therapeutic pulpotomy (excluding final D3221 pulpal debridement, primary and permanent D3222 partial pulpotomy for apexogenesis - D3230 pulpal therapy (resorbable filling) - D3240 pulpal therapy (resorbable filling) - D3310 endodontic therapy, anterior tooth D3320 endodontic therapy, premolar tooth D3330 endodontic therapy, molar tooth (excluding D3331 treatment of root canal obstruction;

D3332 incomplete endodontic therapy; inoperable, D3333 internal root repair of perforation D3346 retreatment of previous root canal therapy D3347 retreatment of previous root canal therapy D3348 retreatment of previous root canal therapy D3351 apexification/recalcification - initial D3352 apexification/recalcification - interim D3353 apexification/recalcification - final D3355 pulpal regeneration - initial visit D3356 pulpal regeneration - interim medication D3357 pulpal regeneration - completion of D3410 apicoectomy - anterior D3421 apicoectomy - premolar (first root) D3425 apicoectomy - molar (first root) D3426 apicoectomy (each additional root) D3427 periradicular surgery without apicoectomy D3428 bone graft in conjunction with D3429 bone graft in conjunction with D3430 retrograde filling - per root D3431 biologic materials to aid in soft and D3432 guided tissue regeneration, resorbable D3450 root amputation - per root D3460 endodontic endosseous implant D3470 intentional reimplantation (including D3910 surgical procedure for isolation of tooth D3920 hemisection (including any root removal), D3950 canal preparation and fitting of preformed D3999 unspecified endodontic procedure, by D4210 gingivectomy or gingivoplasty - four or D4211 gingivectomy or gingivoplasty - one to D4212 gingivectomy or gingivoplasty to allow D4230 anatomical crown exposure - four or more D4231 anatomical crown exposure - one to three D4240 gingival flap procedure, including root D4241 gingival flap procedure, including root D4245 apically positioned flap D4249 clinical crown lengthening - hard tissue D4260 osseous surgery (including elevation of a D4261 osseous surgery (including elevation of a D4263 bone replacement graft - retained natural D4264 bone replacement graft - retained natural D4265 biologic materials to aid in soft and D4266 guided tissue regeneration - resorbable D4267 guided tissue regeneration - nonresorbable D4268 surgical revision procedure, per tooth D4270 pedicle soft tissue graft procedure D4273 autogenous connective tissue graft D4283 autogenous connective tissue graft D4275 non-autogenous connective tissue graft D4285 non-autogenous connective tissue graft D4274 mesial/distal wedge procedure, single D4276 combined connective tissue and double

D4277 free soft tissue graft procedure D4278 free soft tissue graft procedure D4320 provisional splinting - intracoronal D4321 provisional splinting - extracoronal D4341 periodontal scaling and root planing - D4342 periodontal scaling and root planing - one D4346 scaling in presence of generalized D4355 full mouth debridement to enable a D4381 localized delivery of antimicrobial agents D4910 periodontal maintenance D4920 unscheduled dressing change (by someone D4921 gingival irrigation - per quadrant D4999 unspecified periodontal procedure, by D5110 complete denture - maxillary D5120 complete denture - mandibular D5130 immediate denture - maxillary D5140 immediate denture - mandibular D5211 maxillary partial denture - resin base D5212 mandibular partial denture - resin base D5213 maxillary partial denture - cast metal D5214 mandibular partial denture - cast metal D5221 immediate maxillary partial denture - D5222 immediate mandibular partial denture - D5223 immediate maxillary partial denture - cast D5224 immediate mandibular partial denture - D5225 maxillary partial denture - flexible base D5226 mandibular partial denture - flexible base D5281 removable unilateral partial denture - one D5410 adjust complete denture - maxillary D5411 adjust complete denture - mandibular D5421 adjust partial denture - maxillary D5422 adjust partial denture - mandibular D5511 repair broken complete denture base, D5512 repair broken complete denture base, D5520 replace missing or broken teeth - complete D5611 repair resin partial denture base, D5612 repair resin partial denture base, D5621 repair cast partial framework, mandibular D5622 repair cast partial framework, maxillary D5630 repair or replace broken clasp - per tooth D5640 replace broken teeth - per tooth D5650 add tooth to existing partial denture D5660 add clasp to existing partial denture - D5670 replace all teeth and acrylic on cast D5671 replace all teeth and acrylic on cast D5710 rebase complete maxillary denture D5711 rebase complete mandibular denture D5720 rebase maxillary partial denture D5721 rebase mandibular partial denture D5730 reline complete maxillary denture D5731 reline complete mandibular denture D5740 reline maxillary partial denture D5741 reline mandibular partial denture D5750 reline complete maxillary denture D5751 reline complete mandibular denture D5760 reline maxillary partial denture D5761 reline mandibular partial denture D5810 interim complete denture (maxillary) D5811 interim complete denture (mandibular) D5820 interim partial denture (maxillary) D5821 interim partial denture (mandibular) D5850 tissue conditioning, maxillary D5851 tissue conditioning, mandibular D5862 precision attachment, by report D5863 overdenture - complete maxillary D5864 overdenture - partial maxillary D5865 overdenture - complete mandibular D5866 overdenture - partial mandibular D5867 replacement of replaceable part of D5875 modification of removable prosthesis D5899 unspecified removable prosthodontic D5992 adjust maxillofacial prosthetic appliance, D5993 maintenance and cleaning of a D5914 auricular prosthesis D5927 auricular prosthesis, replacement D5987 commissure splint D5924 cranial prosthesis D5925 facial augmentation implant prosthesis D5912 facial moulage (complete) D5911 facial moulage (sectional) D5919 facial prosthesis D5929 facial prosthesis, replacement D5951 feeding aid

D5934 mandibular resection prosthesis with guide D5935 mandibular resection prosthesis without D5913 nasal prosthesis D5926 nasal prosthesis, replacement D5922 nasal septal prosthesis D5932 obturator prosthesis, definitive D5936 obturator prosthesis, interim D5933 obturator prosthesis, modification D5931 obturator prosthesis, surgical D5916 ocular prosthesis D5923 ocular prosthesis, interim D5915 orbital prosthesis D5928 orbital prosthesis, replacement D5954 palatal augmentation prosthesis D5955 palatal lift prosthesis, definitive D5958 palatal lift prosthesis, interim D5959 palatal lift prosthesis, modification D5985 radiation cone locator D5984 radiation shield D5953 speech aid prosthesis, adult D5960 speech aid prosthesis, modification D5952 speech aid prosthesis, pediatric D5988 surgical splint D5982 surgical stent D5937 trismus appliance (not for TMD treatment) D5986 fluoride gel carrier D5994 periodontal medicament carrier with D5983 radiation carrier D5991 vesiculobullous disease medicament carrier D5999 unspecified maxillofacial prosthesis, by D6190 radiographic/surgical implant index, by D6010 surgical placement of implant body:

D6011 second stage implant surgery D6012 surgical placement of interim implant body D6013 surgical placement of mini implant D6040 surgical placement: eposteal implant D6050 surgical placement: transosteal implant D6100 implant removal, by report D6101 debridement of a peri-implant defect or D6102 debridement and osseous contouring of a D6103 bone graft for repair of peri-implant D6104 bone graft at time of implant placement D6055 connecting bar - implant supported or D6056 prefabricated abutment - includes D6057 custom fabricated abutment - includes D6051 interim abutment D6052 semi-precision attachment abutment D6110 implant /abutment supported removable D6111 implant /abutment supported removable D6112 implant /abutment supported removable D6113 implant /abutment supported removable D6114 implant /abutment supported fixed denture D6115 implant /abutment supported fixed denture D6116 implant /abutment supported fixed denture D6117 implant /abutment supported fixed denture D6118 implant/abutment supported interim fixed D6119 implant/abutment supported interim fixed D6058 abutment supported porcelain/ceramic crown D6059 abutment supported porcelain fused to D6060 abutment supported porcelain fused to D6061 abutment supported porcelain fused to D6062 abutment supported cast metal crown (high D6063 abutment supported cast metal crown D6064 abutment supported cast metal crown (noble D6094 abutment supported crown - (titanium) D6065 implant supported porcelain/ceramic crown D6066 implant supported porcelain fused to metal D6067 implant supported metal crown (titanium, D6068 abutment supported retainer for D6069 abutment supported retainer for porcelain D6070 abutment supported retainer for porcelain D6071 abutment supported retainer for porcelain D6072 abutment supported retainer for cast metal D6073 abutment supported retainer for cast metal D6074 abutment supported retainer for cast metal D6194 abutment supported retainer crown for FPD D6075 implant supported retainer for ceramic FPD D6076 implant supported retainer for porcelain D6077 implant supported retainer for cast metal D6080 implant maintenance procedures when D6081 scaling and debridement in the presence of D6085 provisional implant crown D6090 repair implant supported prosthesis, by

D6091 replacement of semi-precision or precision D6092 re-cement or re-bond implant/abutment D6093 re-cement or re-bond implant/abutment D6095 repair implant abutment, by report D6096 remove broken implant retaining screw D6199 unspecified implant procedure, by report D6205 pontic - indirect resin based composite D6210 pontic - cast high noble metal D6211 pontic - cast predominantly base metal D6212 pontic - cast noble metal D6214 pontic - titanium D6240 pontic - porcelain fused to high noble D6241 pontic - porcelain fused to predominantly D6242 pontic - porcelain fused to noble metal D6245 pontic - porcelain/ceramic D6250 pontic - resin with high noble metal D6251 pontic - resin with predominantly base D6252 pontic - resin with noble metal D6253 provisional pontic - further treatment or D6545 retainer - cast metal for resin bonded D6548 retainer - porcelain/ceramic for resin D6549 resin retainer - for resin bonded fixed D6600 retainer inlay - porcelain/ceramic, two D6601 retainer inlay - porcelain/ceramic, three D6602 retainer inlay - cast high noble metal, D6603 retainer inlay - cast high noble metal, D6604 retainer inlay - cast predominantly base D6605 retainer inlay - cast predominantly base D6606 retainer inlay - cast noble metal, two D6607 retainer inlay - cast noble metal, three D6624 retainer inlay - titanium D6608 retainer onlay - porcelain/ceramic, two D6609 retainer onlay - porcelain/ceramic, three D6610 retainer onlay - cast high noble metal, D6611 retainer onlay - cast high noble metal, D6612 retainer onlay - cast predominantly base D6613 retainer onlay - cast predominantly base D6614 retainer onlay - cast noble metal, two D6615 retainer onlay - cast noble metal, three D6634 retainer onlay - titanium D6710 retainer crown - indirect resin based D6720 retainer crown - resin with high noble D6721 retainer crown - resin with predominantly D6722 retainer crown - resin with noble metal D6740 retainer crown - porcelain/ceramic D6750 retainer crown - porcelain fused to high D6751 retainer crown - porcelain fused to D6752 retainer crown - porcelain fused to noble D6780 retainer crown - 3/4 cast high noble metal D6781 retainer crown - 3/4 cast predominantly D6782 retainer crown - 3/4 cast noble metal D6783 retainer crown - 3/4 porcelain/ceramic D6790 retainer crown - full cast high noble D6791 retainer crown - full cast predominantly D6792 retainer crown - full cast noble metal D6794 retainer crown - titanium D6793 provisional retainer crown - further D6920 connector bar D6930 re-cement or re-bond fixed partial denture D6940 stress breaker D6950 precision attachment D6980 fixed partial denture repair necessitated D6985 pediatric partial denture, fixed D6999 unspecified fixed prosthodontic procedure, D7111 extraction, coronal remnants - primary D7140 extraction, erupted tooth or exposed root D7210 extraction, erupted tooth requiring D7220 removal of impacted tooth - soft tissue D7230 removal of impacted tooth - partially bony D7240 removal of impacted tooth - completely D7241 removal of impacted tooth - completely D7250 removal of residual tooth roots (cutting D7251 coronectomy - intentional partial tooth D7260 oroantral fistula closure D7261 primary closure of a sinus perforation D7270 tooth reimplantation and/or stabilization D7272 tooth transplantation (includes D7280 exposure of an unerupted tooth D7282 mobilization of erupted or malpositioned D7283 placement of device to facilitate eruption D7285 incisional biopsy of oral tissue-hard D7286 incisional biopsy of oral tissue-soft D7287 exfoliative cytological sample collection

D7288 brush biopsy - transepithelial sample D7290 surgical repositioning of teeth D7291 transseptal fiberotomy/supra crestal D7292 placement of temporary anchorage device D7293 placement of temporary anchorage device D7294 placement of temporary anchorage device D7295 harvest of bone for use in autogenous D7296 corticotomy - one to three teeth or tooth D7297 corticotomy - four or more teeth or tooth D7310 alveoloplasty in conjunction with D7311 alveoloplasty in conjunction with D7320 alveoloplasty not in conjunction with D7321 alveoloplasty not in conjunction with D7340 vestibuloplasty - ridge extension D7350 vestibuloplasty - ridge extension D7410 excision of benign lesion up to 1.25 cm D7411 excision of benign lesion greater than D7412 excision of benign lesion, complicated D7413 excision of malignant lesion up to 1.25 cm D7414 excision of malignant lesion greater than D7415 excision of malignant lesion, complicated D7465 destruction of lesion(s) by physical or D7440 excision of malignant tumor - lesion D7441 excision of malignant tumor - lesion D7450 removal of benign odontogenic cyst or D7451 removal of benign odontogenic cyst or D7460 removal of benign nonodontogenic cyst or D7461 removal of benign nonodontogenic cyst or D7471 removal of lateral exostosis (maxilla or D7472 removal of torus palatinus D7473 removal of torus mandibularis D7485 reduction of osseous tuberosity D7490 radical resection of maxilla or mandible D7510 incision and drainage of abscess - D7511 incision and drainage of abscess - D7520 incision and drainage of abscess - D7521 incision and drainage of abscess - D7530 removal of foreign body from mucosa, skin, D7540 removal of reaction producing foreign D7550 partial ostectomy/sequestrectomy for D7560 maxillary sinusotomy for removal of tooth D7610 maxilla - open reduction (teeth D7620 maxilla - closed reduction (teeth D7630 mandible - open reduction (teeth D7640 mandible - closed reduction (teeth D7650 malar and/or zygomatic arch - open D7660 malar and/or zygomatic arch - closed D7670 alveolus - closed reduction, may include D7671 alveolus - open reduction, may include D7680 facial bones - complicated reduction with D7710 maxilla - open reduction D7720 maxilla - closed reduction D7730 mandible - open reduction D7740 mandible - closed reduction D7750 malar and/or zygomatic arch - open D7760 malar and/or zygomatic arch - closed D7770 alveolus - open reduction stabilization of D7771 alveolus, closed reduction stabilization D7780 facial bones - complicated reduction with D7810 open reduction of dislocation D7820 closed reduction of dislocation D7830 manipulation under anesthesia D7840 condylectomy D7850 surgical discectomy, with/without implant D7852 disc repair D7854 synovectomy D7856 myotomy D7858 joint reconstruction D7860 arthrotomy D7865 arthroplasty D7870 arthrocentesis D7871 non-arthroscopic lysis and lavage D7872 arthroscopy - diagnosis, with or without D7873 arthroscopy: lavage and lysis of adhesions D7874 arthroscopy: disc repositioning and D7875 arthroscopy: synovectomy D7876 arthroscopy: discectomy D7877 arthroscopy: debridement D7880 occlusal orthotic device, by report D7881 occlusal orthotic device adjustment D7899 unspecified TMD therapy, by report D7910 suture of recent small wounds up to 5 cm D7911 complicated suture - up to 5 cm

D7912 complicated suture - greater than 5 cm D7920 skin graft (identify defect covered, D7921 collection and application of autologous D7940 osteoplasty - for orthognathic deformities D7941 osteotomy - mandibular rami D7943 osteotomy - mandibular rami with bone D7944 osteotomy - segmented or subapical D7945 osteotomy - body of mandible D7946 LeFort I (maxilla - total) D7947 LeFort I (maxilla - segmented) D7948 LeFort II or LeFort III (osteoplasty of D7949 LeFort II or LeFort III - with bone graft D7950 osseous, osteoperiosteal, or cartilage D7951 sinus augmentation with bone or bone D7952 sinus augmentation via a vertical approach D7953 bone replacement graft for ridge D7955 repair of maxillofacial soft and/or hard D7960 frenulectomy - also known as frenectomy or D7963 frenuloplasty D7970 excision of hyperplastic tissue - per arch D7971 excision of pericoronal gingiva D7972 surgical reduction of fibrous tuberosity D7979 non - surgical sialolithotomy D7980 surgical sialolithotomy D7981 excision of salivary gland, by report D7982 sialodochoplasty D7983 closure of salivary fistula D7990 emergency tracheotomy D7991 coronoidectomy D7995 synthetic graft - mandible or facial D7996 implant-mandible for augmentation purposes D7997 appliance removal (not by dentist who D7998 intraoral placement of a fixation device D7999 unspecified oral surgery procedure, by D8010 limited orthodontic treatment of the D8020 limited orthodontic treatment of the D8030 limited orthodontic treatment of the D8040 limited orthodontic treatment of the adult D8050 interceptive orthodontic treatment of the D8060 interceptive orthodontic treatment of the D8070 comprehensive orthodontic treatment of the D8080 comprehensive orthodontic treatment of the D8090 comprehensive orthodontic treatment of the D8210 removable appliance therapy D8220 fixed appliance therapy D8660 pre-orthodontic treatment examination to D8670 periodic orthodontic treatment visit D8680 orthodontic retention (removal of D8681 removable orthodontic retainer adjustment D8690 orthodontic treatment (alternative billing D8691 repair of orthodontic appliance D8692 replacement of lost or broken retainer D8693 re-cement or re-bond fixed retainer D8694 repair of fixed retainers, includes D8695 removal of fixed orthodontic appliances D8999 unspecified orthodontic procedure, by D9110 palliative (emergency) treatment of dental D9120 fixed partial denture sectioning D9210 local anesthesia not in conjunction with D9211 regional block anesthesia D9212 trigeminal division block anesthesia D9215 local anesthesia in conjunction with D9219 evaluation for deep sedation or general D9222 deep sedation/general anesthesia - first D9223 deep sedation/general anesthesia - each D9230 inhalation of nitrous oxide/analgesia, D9239 intravenous moderate (conscious) D9243 intravenous moderate (conscious) D9248 non-intravenous conscious sedation D9310 consultation - diagnostic service provided D9311 consultation with a medical health care D9410 house/extended care facility call D9420 hospital or ambulatory surgical center D9430 office visit for observation (during D9440 office visit - after regularly scheduled D9450 case presentation, detailed and extensive D9610 therapeutic parenteral drug, single D9612 therapeutic parenteral drugs, two or more D9630 drugs or medicaments dispensed in the D9910 application of desensitizing medicament D9911 application of desensitizing resin for D9920 behavior management, by report D9930 treatment of complications (post-surgical)

D9932 cleaning and inspection of removable D9933 cleaning and inspection of removable D9934 cleaning and inspection of removable D9935 cleaning and inspection of removable D9940 occlusal guard, by report D9941 fabrication of athletic mouthguard D9942 repair and/or reline of occlusal guard D9943 occlusal guard adjustment D9950 occlusion analysis - mounted case D9951 occlusal adjustment - limited D9952 occlusal adjustment - complete D9970 enamel microabrasion D9971 odontoplasty 1 - 2 teeth; includes removal D9972 external bleaching - per arch - performed D9973 external bleaching - per tooth D9974 internal bleaching - per tooth D9975 external bleaching for home application, D9985 sales tax D9986 missed appointment D9987 cancelled appointment D9991 dental case management - addressing D9992 dental case management - care coordination D9993 dental case management - motivational D9994 dental case management - patient education D9995 teledentistry - synchronous; real-time D9996 teledentistry - asynchronous; information D9999 unspecified adjunctive procedure, by D5510 repair broken complete denture base D5610 repair resin denture base D5620 repair cast framework