Adult Dental Covered Codes

amalgam - 4+ surface crown - porcelain/ceramic D7485 crown - resin/metal base D7220 complete denture - mand removal of torus palatinus D2740 D5612 reline- complete denture - max - lab D5611 D5214 D5731 scaling and root planing - 4+ teeth per quad D5213 D5730 fluoride varnish D3310 D5212 D5211 repair - cast partial framework, maxillary composite - 1 surface posterior amalgam - 3 surface composite - 1 surface anterior alveoloplasty w/ extractions - 1 - 3 teeth/spaces per quad removable unilateral partial denture – one-piece resin (including clasps and teeth) – per quadrant surgical removal of residual roots panoramic film removable unilateral partial denture – one-piece cast metal (including clasps and teeth), maxillary removable unilateral partial denture – one-piece cast metal (including clasps and teeth), mandibular D7250 alveoloplasty w/o extractions - 1 - 3 teeth/spaces per quad composite - 2 surface posterior D5110 limited oral evaluation topical fluoride application of hydroxyapatite regeneration medicament – per tooth D0330 D2751 D0210 D2750 D2753 D5622 alveoloplasty w/ extractions per quad D2752 D5621 Inhalation of nitrous oxide/ analgesia D3320 D2991 reline - complete denture - mand - lab composite - 3 surface anterior repair resin partial denture base, mandibular bitewing - four films detailed & extensive oral evaluation crown - resin/metal noble partial denture - metal base - max removable unilateral partial denture – one-piece flexible base (including clasps and teeth) – per quadrant D5286 crown - porcelain/metal base extraction - surgical D5284 D0270 D5283 composite - 3 surface posterior D5282 D1354 DESCRIPTION D0140 D1110 D4341 D4342 D2722 D2721 immediate denture - max composite - 4+ surface anterior crown - prefab stainless steel - permanent D7471 D7472 D7473 reline - complete denture - mand - chairside crown - 3/4/metal noble D0160 endodontic therapy, premolar tooth (excluding final restoration) crown - porcelain/metal noble crown - full metal base D2332 crown - 3/4 metal base D2335 D0150 bitewing - three films D0272 D4355 partial denture - resin base - max D0273 D2331 D0274 D2330 D4910 bitewing - two films D7284 D7320 D7321 D2391 D5660 D2393 scaling and root planing - 1 to 3 teeth/quad amalgam - 1 surface D2150 D2392 D5140 composite - 2 surface anterior periodic oral evaluation D2783 D2782 D0120 prophylaxis - adult crown - porcelain fused to titanium and titanium alloys D2781 D5650 endodontic therapy, molar tooth (excluding final restoration) D7311 D2920 D0367 composite - 4+ surface posterior crown - porcelain/metal high noble full mouth debridement to enable a comprehensive oral evaluation and diagnosis on a subsequent visit bitewing - single film D9230 repair resin partial denture base, maxillary D9110 extraction - erupted tooth or exposed root D7210 D2160 removal of torus mandibularis D2161 complete denture - max partial denture - metal base - mand comprehensive oral evaluation D2791 D2394 D2792 crown - full metal noble periodontal maintenance immediate denture - mand repair - cast partial framework, mandibular D5120 D7140 impaction - soft tissue palliative treatment D0220 endodontic therapy, anterior tooth (excluding final restoration) excisional biopsy of minor salivary glands D5630 D5751 D5750 D3330 amalgam - 2 surface partial denture - resin base - mand add clasp - partial denture cone beam CT capture and interpretation with field of view of both jaws, with or without cranium intraoral - periapical 1st film replace - missing/broken teeth - partial D7310 surgical reduction of tuberosity intraoral - complete series crown - 3/4 porcelain/ceramic D2140 D5130 intraoral - periapical each additional interim caries arresting medicament application - per tooth removal of lateral exostosis - max or mand CODE reline- complete denture - max - chairside recement crown D5640 D0230 repair - broken clasp partial denture D1208 D2931 D1206 add tooth - partial denture alveoloplasty w/o extractions per quad