Adult Dental Covered Codes

bitewings - three radiographic images crown - resin with noble metal crown - porcelain/ceramic D7485 extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated crown - porcelain fused predominantly base metal complete denture - maxillary removal of torus palatinus D2740 alveoloplasty not in conjuction with extractions - four or more teeth or tooth spaces, per quadrant crown - full cast predominantly base metal D5612 removal of lateral exostosis (maxilla or mandible) D5611 D5214 D5731 D5213 D5730 D3310 D5212 D5211 D7250 detailed & extensive oral evaluation- problem focused, by report D5110 removal of residual tooth roots (cutting procedure) crown - porcelain fused to noble metal amalgam - two surfaces, primary or permanent D0330 D2751 D0210 D2750 D2753 D5622 D2752 D5621 D3320 mandibular partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) D2991 alveoloplasty in conjuction with extractions - one to three teeth or tooth spaces, per quadrant repair resin partial denture base, mandibular immediate denture - mandibular D7220 D5286 repair or replace broken retentive/clasping materials - per tooth D5284 D0270 D5283 D5282 D1354 removable unilateral partial denture – one piece flexible base (including retentive/clasping materials, rests, and teeth) – per quadrant crown - porcelain fused to high noble metal crown - 3/4 cast noble metal D0140 D1110 resin-based composite - one surface, anterior D4341 D4342 crown - resin with predominantly base metal D2722 removable unilateral partial denture - one piece cast metal (including retentive/clasping materials, rests, and teeth), mandibular D2721 add tooth to existing partial denture - per tooth amalgam - one surface, primary or permanent removable unilateral partial denture – one piece resin (including retentive/clasping materials, rests, and teeth) – per quadrant D7471 D7472 D7473 resin-based composite - one surface, posterior reline complete maxillary denture (indirect) full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit comprehensive oral evaluation - new or established patient bitewings - two radiographic images D0160 bitewings - four radiographic images endodontic therapy, premolar tooth (excluding final restoration) reline complete mandibular denture (direct) D2332 bitewing - single radiographic image topical application of fluoride varnish D2335 D0150 D0272 D4355 immediate denture - maxillary D0273 D2331 D0274 D2330 intraoral - periapical each additional radiographic image D4910 reduction of osseous tuberosity resin-based composite - two surfaces, posterior replace missing or broken teeth - partial denture - per tooth D7284 palliative treatment of dental pain - per visit panoramic radiographic image D7320 D7321 D2391 periodontal scaling and root planing - four or more teeth per quadrant D5660 D2393 D2150 D2392 crown - 3/4 cast predominantly base metal D5140 resin-based composite - three surfaces, anterior D2783 topical application of fluoride - excluding varnish removable unilateral partial denture - one piece cast metal (including retentive/clasping materials, rests, and teeth), maxillary D2782 D0120 prophylaxis - adult crown - porcelain fused to titanium and titanium alloys D2781 D5650 endodontic therapy, molar tooth (excluding final restoration) D7311 reline complete maxillary denture (direct) intraoral - periapical first radiographic image D0367 resin-based composite - two surfaces, anterior crown - full cast noble metal re-cement or re-bond crown D9230 repair resin partial denture base, maxillary repair cast partial framework, mandibular D9110 reline complete mandibular denture (indirect) resin-based composite - three surfaces, posterior D7210 D2160 removal of torus mandibularis D2161 resin-based composite - four or more surfaces, anterior D2791 D2394 D2792 periodontal maintenance cone beam CT capture and interpretation with field of view of both jaws; with or without cranium limited oral evaluation - problem focused alveoloplasty not in conjuction with extractions - one to three teeth or tooth spaces, per quadrant periodic oral evaluation - established patient mandibular partial denture - resin base (including retentive/clasping materials, rests, and teeth) intraoral - comprehensive series of radiographic images D5120 complete denture - mandibular extraction, erupted tooth or exposed root (elevation and/or forceps removal) application of caries arresting medication - per tooth D7140 D0220 endodontic therapy, anterior tooth (excluding final restoration) excisional biopsy of minor salivary glands D5630 D5751 D5750 D3330 maxillary partial denture - resin base (including retentive/clasping materials, rests, and teeth) D2920 add clasp to existing partial denture - per tooth repair cast partial framework, maxillary application of hydroxyapatite regeneration medicament - per tooth alveoloplasty in conjuction with extractions - four or more teeth or tooth spaces, per quadrant periodontal scaling and root planing - one to three teeth per quadrant D7310 crown - 3/4 porcelain/ceramic D2140 D5130 prefabricated stainless steel crown - permanent tooth maxillary partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) D5640 D0230 amalgam - three surfaces, primary or permanent administration of nitrous oxide D1208 removal of impacted tooth - soft tissue amalgam - four or more surfaces, primary or permanent resin-based composite - four or more surfaces, posterior D2931 D1206