Exam_Costs_to_Be_Performed_Less_Costs.xlsx
XLSX spreadsheet 11 KB Posted
- Attached to
- Idaho Army National Guard Dental Service
- Solicitation number
- W912J7-18-R-0018
About this file
IDARNG PWS Dental Cost Attachment 1
View the file
Other files
| File | Type | Posted |
|---|---|---|
| PWS_Dental_22_Sep_18.docx | DOCX document | |
| Questions_received_19_September_2018.pdf | ||
| PWS_Dental_17_Sep_18.pdf | ||
| CLIN_Structure_W912J7-18-R-0018_17_Sep_18.pdf | ||
| PPQ_W912J7-18-R-0018_17_Sep_18.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Sheet1
| CLIN 0001 | ||
| A. DIAGNOSTIC SERVICES | Cost Per Service | |
| D0140 - Limited Oral Evaluation-problem focused | ||
| D0272 - Bitewings-Two Films | ||
| D0274 - Bitewings-Four Films | ||
| D0220/D0230 - Periapical Film(s) (limited) | ||
| D0140 - Limited Oral Evaluation-problem focused | ||
| D0330 - Panoramic Film (for 3rd molar removal evaluation only) |
| CLIN 0002 | |
| B. RESTORATIVE SERVICES | |
| D2140 - Amalgam One Surface | |
| D2150 - Amalgam Two Surfaces | |
| D2160 Amalgam - Three Surfaces | |
| D2161 - Amalgam - Four or More Surfaces | |
| D2330 - Composite (Anterior) One Surface | |
| D2331 - Composite (Anterior) - Two Surfaces | |
| D2332 - Composite (Anterior) Three Surfaces | |
| D2335 - Composite (Anterior) Four(+) Surfaces/Incisal | |
| D2931 - Prefabricated Stainless Steel Crown | |
| D2950 - Core Buildup, including any pins | |
| D2951 - Pin retention for large restorations | |
| D2954 - Prefabricated Post and Core | |
| All restorations should be coded per tooth, not per number of restorations, e.g. a DO and an F | |
| on the same tooth should be considered a 3 surface restoration for that tooth, not two separate restorations. Any questions please call prior to sending charges. | |
| C. ENDODONTIC SERVICES (RCT-Root Canal Therapy) | |
| D3310 - Anterior RCT; D3320- Bicuspid RCT; D3330 - Molar RCT | |
| D3346 - Anterior Retreatment; D3347 - Bicuspid Retreatment; D3348 - Molar Retreatment | |
| D. PERIODONTAL SERVICES (only when Memorandum identifies procedure) | |
| D4355 - Full Mouth Debridement; D4342 - Periodontal Scaling/Root Planing, 1 to 3 teeth per quadrant | |
| Periodontal scaling and root planing is authorized ONLY when a periodontal abscess is present. | |
| E. P ROSTHODONTIC SER VICES | |
| D5110 - Complete Denture - Ma,-xillary; DS 120 - Complete Denture - Mandibular | |
| F. ORAL SURGERY SERVICES | |
| D7140 -Extraction, Erupted Tooth or Exposed Root | |
| D7210 - Surgical Removal of Erupted Tooth | |
| D7220 - Removal of Impacted Tooth, Soft Tissue | |
| D7230-Removal of Impacted Tooth, Partial Bony | |
| D7240 - Removal of Impacted Tooth, Full Bony |
| IV sedation and other IV medications are authorized only for Oral Surgery procedures (if necessary). |
| **Prior to submission of hard or soft tissue biopsies for pathos is evaluation, please contact the State Surgeon's |
| Office. |
File details come from the government source that posted it.