Childrens Dental Covered Codes

free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant, or edentulous tooth position in graft bitewings - three radiographic images crown - resin with noble metal re-cement or re-bond bilateral space maintainer - mandibular apexification/recalcification - initial visit (apical closure/calcific repair of perforations, root resorption, etc.) removal of fixed orthodontic appliances for reasons other than completion of treatment retainer crown - 3/4 cast high noble metal D4249 D9939 D4245 D9930 D7510 D7511 D7997 pre-orthodontic treatment examination to monitor growth and development D9950 D7530 D5110 D4263 trigeminal division block anesthesia D4260 D4261 apexification/recalcification - interim medication replacement veneer repair necessitated by restorative material failure implant supported crown - porcelain fused to titanium and titanium alloys guided tissue regeneration, edentulous area - resorbable barrier, per site D7520 D9941 surgical removal of implant body D9943 D9945 D9944 D9946 surgical placement: transosteal implant retainer inlay - titanium D7971 excision of periocoronal gingiva D7972 D9910 D9911 space maintainer - fixed - bilateral, mandibular reline complete maxillary denture (indirect) cone beam CT capture and interpretation with limited field of view of one full dental arch - mandible frenuloplasty D4240 D4241 retainer inlay - cast noble metal, three or more surfaces treatment of complications (post surgical) - unusual circumstances, by report limited orthodontic treatment of the adolescent dentition immediate maxillary partial denture - flexible base (including any clasps, rests and teeth) 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 abutment supported retainer for porcelain fused to metal FPD (noble metal) local anesthesia not in conjunction with operative or surgical procedures maxillary partial denture - flexible base (including retentive/clasping materials, rests, and teeth) replace missing or broken teeth - partial denture - per tooth implant supported retainer for metal FPD – titanium and titanium alloys abutment supported porcelain/ceramic crown D3357 decoronation or submergence of an erupted tooth D7957 D6624 D3355 D3356 D3353 D3351 crown - porcelain fused to titanium and titanium alloys D3110 D3352 immediate mandibular partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) space maintainer - removable, unilateral - per quadrant intraoral - periapical first radiographic image therapeutic parenteral drug, single administration D7953 coping retainer crown - resin with high noble metal D7956 interim complete denture (mandibular) D7970 retreatment of previous root canal therapy - anterior exfolliative cytological sample collection prefabricated abutment - includes modification and placement D6634 cone beam CT capture and interpretation with limited field of view of one full dental arch - maxilla, with or without cranium D4211 D3120 D4210 immediate maxillary partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) D7961 D7962 D7963 crown - 3/4 resin-based composite (indirect) D6603 D6602 D3333 D5512 D6601 D5511 D6600 D3331 excisional biopsy of minor salivary glands D3332 apicoectomy (each additional root) D5751 D5993 abutment supported retainer - porcelain fused to titanium and titanium alloys D5750 D5992 D3330 adjust complete denture - mandibular D6609 pulp cap - direct (excluding final restoration) D6608 add clasp to existing partial denture - per tooth implant supported crown - noble alloys D6607 D6606 D6605 D6604 removable appliance therapy occlusal adjustment - limited adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignant and malignant lesions, not to include cytology or biopsy procedures regional block anesthesia guided tissue regeneration, natural teeth – non-resorbable barrier, per site pontic - resin with noble metal tissue conditioning, mandibular D3346 D6614 D3347 D6613 D5765 D6612 D6611 D6610 D5520 D5761 D5760 removal of impacted tooth - soft tissue excision of benign lesion up to 1.25 cm implant/abutment supported removable denture for edentulous arch - maxillary pontic - porcelain/ceramic D3348 precision attachment abutment supported retainer crown for FPD - titanium and titanium alloys D6615 intraoral tomosynthesis - periapical radiographic image implant/abutment supported removable denture for partially edentulous arch - mandibular internal root repair of perforation defects extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated alveoloplasty not in conjuction with extractions - four or more teeth or tooth spaces, per quadrant distal shoe space maintainer – fixed, unilateral - per quadrant osseous surgery (including elevation of a full thickness flap and closure) - one to three contiguous teeth or tooth bounded spaces per quadrant D5731 D5730 D3310 limited orthodontic treatment of the adult dentition D7910 occlusal adjustment - complete immediate mandibular partial denture - resin base (including retentive/clasping materials, rests and teeth) occlusal orthotic device adjustment each additional prefabricated post - same tooth crown - resin with high noble metal D3320 D5741 D5740 immediate denture - mandibular local anesthesia in conjunction with operative or surgical procedures D0270 D1354 administration of moderate sedation - enteral D1353 D5711 D5710 D1110 resin-based composite - one surface, anterior D1351 biologic materials to aid in soft and osseous tissue regeneration, per site overdenture - partial mandibular - natural tooth borne add tooth to existing partial denture - per tooth partial extraction for immediate implant placement removable unilateral partial denture – one piece resin (including retentive/clasping materials, rests, and teeth) – per quadrant adjustment - partial denture - mandibular resin-based composite - one surface, posterior inlay - porcelain/ceramic - two surfaces retainer onlay - cast noble metal, three or more surfaces oroantral fistula closure re-evaluation - post-operative office visit 2D oral/facial photographic image obtained intra-orally or extra-orally comprehensive oral evaluation - new or established patient bitewings - two radiographic images D0277 topical application of fluoride varnish D5721 D5720 D0272 D0273 pulpal regeneration - completion of treatment D0274 collection and preparation of saliva sample for laboratory analysis D1120 inlay - resin-based composite - one surface D5725 nerve dissection space maintainer - fixed - bilateral, maxillary hemisection (including any root removal), not including root canal therapy crown - 3/4 cast predominantly base metal retainer - porcelain/ceramic for resin bonded fixed prosthesis D2663 D2662 pontic - cast noble metal topical application of fluoride - excluding varnish D1575 D2664 D0240 sealant - per tooth resin retainer - for resin bonded fixed prosthesis resin-based composite - three surfaces, posterior 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 removal of torus mandibularis occlusal guard - soft appliance, full arch D0250 tomographic survey D0251 destruction of lesion(s) by physical or chemical method, by report limited oral evaluation - problem focused periodic oral evaluation - established patient soft liner for complete or partial removable denture - indirect intraoral - comprehensive series of radiographic images space maintainer - fixed, unilateral - per quadrant abutment supported retainer for cast metal FPD (predominantly base metal) D0220 D1552 implant supported retainer for FPD - porcelain fused to noble alloys D1551 limited orthodontic treatment of the transitional dentition D2643 D1553 D2642 D0460 D0461 D1556 inlay - resin-based composite - three or more surfaces D2644 D1558 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 D1557 occlusal guard adjustment periodontal scaling and root planing - one to three teeth per quadrant crown - 3/4 porcelain/ceramic maxillary partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) D2652 D2651 suture of recent small wounds up to 5 cm application of desensitizing medicament D0470 D2650 D0230 pulpal therapy (resorbable filling) - posterior, primary tooth (excluding final restoration) replacement of replaceable part of semi-precision or precision attachment of implant/abutment supported prosthesis, per attachment inlay - metallic - two surfaces D2620 inlay repair necessitated by restorative material failure maintenance and cleaning of a maxillofacial prosthesis (extra- or intra-oral) other than required adjustments, by report pontic - resin with predominantly base metal stress breaker custom fabricated abutment - includes placement gingival flap procedure, including root planing - one to three contiguous teeth or tooth bounded spaces per quadrant retainer crown - 3/4 porcelain/ceramic sialography D2630 D0210 removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue excision of hyperplastic tissue - per arch pontic - resin with high noble metal mandibular partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) alveoloplasty in conjuction with extractions - one to three teeth or tooth spaces, per quadrant interim crown - further treatment or completion of diagnosis necessary prior to final impression guided tissue regeneration, edentulous area - non-resorbable barrier, per site D9243 D9244 D9245 D9246 retainer crown - titanium and titanium alloys splint - intra-coronal; natural teeth or prosthetic crowns pulpal regeneration - initial visit D1510 crown - 3/4 cast noble metal fixed appliance therapy D0426 D1516 fabrication of athletic mouthguard D1517 D9239 abutment supported retainer for porcelain fused to metal FPD (high noble metal) implant/abutment supported fixed denture for partially edentulous arch - maxillary D0425 onlay - porcelain/ceramic - two surfaces administration of general anesthesia with advanced airway - each subsequent 15 minute increment, or any portion thereof endodontic therapy, premolar tooth (excluding final restoration) surgical placement of mini implant D0431 D2610 D1520 immediate denture - maxillary inlay - resin-based composite - two surfaces post removal D1527 D9247 D1526 guided tissue regeneration – non-resorbable barrier, per implant D6191 D7282 diagnostic casts D7283 D7284 D7285 D7286 D9222 D7287 D9223 extra-oral - 2D projection radiographic image created using a stationary radiation source, and detector D9224 D6197 D6195 D6194 temporomandibular joint arthrogram, including injection non-autogenous connective tissue graft procedure (including recipient site and donor material) first tooth, implant, or edentulous tooth position in graft D6192 retainer inlay - cast high noble metal, two surfaces D7280 space maintainer - removable - bilateral, maxillary pediatric partial denture, fixed core buildup, including any pins when required D9215 mobilization of erupted or malpositioned tooth to aid eruption resin-based composite - two surfaces, anterior reline maxillary partial denture (indirect) D3910 surgical repositioning of teeth onlay repair necessitated by restorative material failure D9230 cone beam CT capture and interpretation with limited field of view - less than one whole jaw re-cement or re-bond indirectly fabricated or prefabricated post and core mesial/distal wedge procedure, single tooth (when not performed in conjunction with surgical procedures in the same anatomical area) implant/abutment supported fixed denture for edentulous arch - maxillary D7290 D7291 prefabricated post and core in addition to crown repair broken complete denture base, mandibular D0415 D9225 fixed partial denture sectioning D0417 alveoloplasty not in conjuction with extractions - one to three teeth or tooth spaces, per quadrant D3920 surgical repair of root resorption - premolar D3921 collection of microorganisms for culture and sensitivity D7260 D9440 splint - extra-coronal; natural teeth or prosthetic crowns onlay - porcelain/ceramic - four or more surfaces bone replacement graft for ridge preservation - per site endodontic therapy, anterior tooth (excluding final restoration) scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation incisional biopsy of oral tissue - hard (bone, tooth) D7259 implant supported crown - porcelain fused to noble alloys application of hydroxyapatite regeneration medicament - per tooth D6180 D7270 D7272 D9210 apically positioned flap D9211 D9212 surgical revision procedure, per tooth re-cement or re-bond fixed retainer - maxillary crown - titanium and titanium alloys implant supported crown - porcelain fused to high noble alloys placement of interim direct restoration resin-based composite - four or more surfaces, posterior retainer inlay - cast high noble metal, three or more surfaces crown - porcelain/ceramic D7240 D7241 D9420 D7485 application of desensitizing resin for cervical and/or root surface, per tooth crown - porcelain fused predominantly base metal retainer crown - ¾ titanium and titanium alloys pontic - indirect resin based composite removal of lateral exostosis (maxilla or mandible) removal of fixed bilateral space maintainer - mandibular root amputation - per root D7250 D7251 D7252 D9430 detailed & extensive oral evaluation- problem focused, by report removal of residual tooth roots (cutting procedure) amalgam - two surfaces, primary or permanent 2D cephalometric radiographic image - acquisition, measurement, and analysis clinical crown lengthening - hard tissue bone replacement graft - retained natural tooth - first site in quadrant implant supported porcelain/ceramic crown intraoral tomosynthesis - bitewing radiographic image repair resin partial denture base, mandibular prefabricated resin crown abutment supported cast metal crown (noble metal) retainer crown - 3/4 cast predominantly base metal removal of benign odontogenic cyst or tumor - lesion diameter up to 1.25 cm retainer onlay - cast high noble metal, three or more surfaces D7460 retainer crown - porcelain fused to titanium and titanium alloys D7220 D5286 D5284 D5283 D5282 crown - porcelain fused to high noble metal overdenture - complete maxillary - natural tooth borne onlay - metallic - three surfaces prophylaxis - child D6123 odontoplasty - per tooth sealant repair - per tooth retainer crown - 3/4 cast noble metal D7471 D7230 D7472 D7473 onlay - resin-based composite - four or more surfaces retainer inlay - porcelain/ceramic, three or more surfaces reline maxillary partial denture (direct) retainer inlay - cast noble metal, two surfaces 3D intraoral surface scan - direct treatment of root canal obstruction; non-surgical access D7465 administration of deep sedation/general anesthesia - first 15 minute increment, or any portion thereof intentional re-implantation (including necessary splinting) D0804 implant supported retainer - porcelain fused to predominantly base alloys D7440 post and core in addition to crown, indirectly fabricated D6111 D6110 implant supported retainer for metal FPD – noble alloys D6107 D6106 D6105 placement of device to facilitate eruption of impacted tooth D6104 D6103 D6102 D6101 implant supported retainer for metal FPD – predominantly base alloys D9610 D0801 reline complete maxillary denture (direct) D0802 D9612 D0803 re-cement or re-bond crown repair cast partial framework, mandibular D7450 D7210 D9630 D6122 D6121 D6120 resin-based composite - four or more surfaces, anterior D6117 overdenture - partial maxillary - natural tooth borne D6116 D6115 D6114 D6113 periodontal maintenance D6112 pontic - cast high noble crown osseous surgery (including elevation of a full thickness flap and closure) - four or more contiguous teeth or tooth bounded spaces per quadrant administration of general anesthesia with advanced airway - first 15 minute increment, or any portion thereof removal of fixed bilateral space maintainer - maxillary occlusal guard - hard appliance, full arch complete denture - mandibular extraction, erupted tooth or exposed root (elevation and/or forceps removal) replace all teeth and acrylic on cast metal framework (maxillary) implant/abutment supported fixed denture for partially edentulous arch - mandibular D7410 maxillary partial denture - resin base (including retentive/clasping materials, rests, and teeth) D7413 surgical placement of implant body: endosteal implant semi-precision abutment - placement D6100 reline mandibular partial denture (indirect) resin-based composite crown, anterior appliance removal (not by dentist who placed appliance), includes removal of archbar D7880 D7881 D6792 bone graft for repair of peri-implant defect – does not include flap entry and closure D6791 D6790 add metal substructure to acrylic complete denture - per arch D6548 D5214 tissue conditioning, maxillary D6545 D5213 D5212 D5211 D6784 D6783 precision attachment, by report D6549 crown - 3/4 cast high noble metal D4381 onlay - resin-based composite - two surface D5228 D5227 D5226 D5225 D5224 D5223 D5222 D5221 D6794 retainer crown - porcelain fused to high noble metal pontic - porcelain fused to noble metal bone replacement graft - retained natural tooth - each additional site in quadrant placement of a custom removable clear plastic temporary aesthetic appliance D4346 onlay - resin-based composite - three surfaces D4341 D4342 crown repair necessitated by restorative material failure periodic orthodontic treatment visit D8703 D8704 full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit D6782 D6781 D6780 intraoral tomosynthesis - comprehensive series of radiographic images reline complete mandibular denture (direct) overdenture - complete mandibular - natural tooth borne pulp cap - indirect (excluding final resoration) D4355 reline mandibular partial denture (direct) inlay - metallic - one surface D2391 D5660 D2390 D3240 D2393 D2150 D2392 D4323 D6985 D5411 D4322 D5410 D3230 D3472 D6740 D3473 D5650 vestibuloplasty - ridge extension (including soft tissue grafts, muscle reattachment, revision of soft tissue attachment and management of hypertrophied and hyperplastic tissue) reline complete mandibular denture (indirect) D2160 D5671 D5670 implant/abutment supported fixed denture for edentulous arch - mandibular D2161 occlusion analysis - mounted case space maintainer - removable - bilateral, mandibular D5422 implant supported retainer for metal FPD - high noble alloys D6753 D2394 prefabricated porcelain/ceramic crown - primary tooth D5421 D6752 retainer crown - full cast noble metal D6751 interim partial denture (including retentive/clasping materials, rests, and teeth), maxillary D6750 cone beam CT capture and interpretation with field of view of both jaws; with or without cranium bone graft at time of implant placement mandibular partial denture - resin base (including retentive/clasping materials, rests, and teeth) D3460 retreatment of previous root canal therapy - premolar retainer crown - resin with predominantly base metal endodontic endosseous implant vestibuloplasty - ridge extension (secondary epithelialization) D5876 D5875 D6722 D6721 D6720 D5630 D3450 retainer crown - full cast high noble metal onlay - porcelain/ceramic - three surfaces 3D facial surface scan - indirect repair cast partial framework, maxillary abutment supported porcelain fused to metal crown (high noble metal) D3470 D6980 D3471 D2140 replace all teeth and acrylic on cast metal framework (mandibular) D3221 D3222 D5640 amalgam - three surfaces, primary or permanent D3220 retainer onlay - cast high noble metal, two surfaces prefabricated stainless steel crown - primary tooth apicoectomy - premolar (first root) coronectomy - intentional partial tooth removal, impacted teeth only 3D dental surface scan - indirect complete denture - maxillary D0170 D0171 removal of torus palatinus crown - full cast predominantly base metal D5612 D5611 D3430 D5851 D6940 orthodontic retention (removal of appliances, construction and placement of retainer(s)) D5850 semi-precision attachment - placement re-cement or re-bond fixed partial denture incision and drainage of abscess - intraoral soft tissue - complicated (includes drainage of multiple fascial spaces) D0180 crown - porcelain fused to noble metal D5866 D5865 D5622 D5864 retrograde filling - per root D5621 D5863 D6710 D5862 D6950 excision of benign lesion greater than 1.25 cm D5867 abutment supported cast metal crown (high noble metal) implant supported crown - titanium and titanium alloys D0145 re-cement or re-bond bilateral space maintainer - maxillary D3410 D6920 gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quadrant D0140 abutment supported retainer for porcelain/ceramic FPD amalgam - one surface, primary or permanent onlay - metallic - four or more surfaces exposure of an unerupted tooth mandibular partial denture - flexible base (including retentive/clasping materials, rests, and teeth) D0160 cone beam CT capture and interpretation for TMJ series including two or more exposures D2332 D2335 D3421 D6930 D0150 D2331 D2330 intraoral - periapical each additional radiographic image retainer crown - porcelain fused to predominantly base metal D3425 implant maintenance procedure when a full arch fixed hybrid prosthesis is not removed, including cleansing of prosthesis and abutments D3426 resin-based composite - two surfaces, posterior pulpal therapy (resorbable filling) - anterior, primary tooth (excluding final restoration) panoramic radiographic image fixed partial denture repair necessitated by restorative material failure D8090 D2542 D5811 D0364 D2783 D5810 D0365 D2544 D0366 D2543 D2780 abutment supported retainer for cast metal FPD (high noble metal) retainer crown - porcelain fused to noble metal D2782 D0120 D2781 autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant or edentulous tooth position in graft endodontic therapy, molar tooth (excluding final restoration) D0367 crown - full cast noble metal D0368 free soft tissue graft procedure (including recipient and donor surgical sites) each additional contiguous tooth, implant, or edentulous tooth position in same graft site re-evaluation - limited, problem focused (established patient; not post-operative visit) retainer onlay - porcelain/ceramic, two surfaces removal of fixed unilateral space maintainer - per quadrant modification of removable prosthesis following implant surgery oral evaluation for a patient under three years of age and counseling with primary caregiver each additional indirectly fabricated post - same tooth abutment supported crown - titanium and titanium alloys pontic - porcelain fused to high noble metal D0374 abutment supported retainer for cast metal FPD (noble metal) D2794 D5821 D5820 D2791 D2790 rebase mandibular partial denture D0372 comprehensive periodontal evaluation - new or established patient D0373 D2792 abutment supported porcelain fused to metal crown (noble metal) D2799 extra-oral posterior dental radiographic image administration of moderate sedation - intravenous - each subsequent 15 minute increment, or any portion thereof rebase maxillary partial denture abutment supported crown - porcelain fused to titanium and titanium alloys therapeutic parenteral drug, two or more administrations, different medications administration of moderate sedation - non-intravenous parenteral – each subsequent 15 minute increment, or any portion thereof retainer onlay - porcelain/ceramic, three or more surfaces D8070 administration of moderate sedation - non-intravenous parenteral – first 15 minute increment, or any portion thereof D2520 administration of deep sedation/general anesthesia - each subsequent 15 minute increment, or any portion thereof guided tissue regeneration, natural teeth - resorbable barrier, per site repair of implant/abutment supported prosthesis re-cement or re-bond fixed retainer - mandibular removal of implant body not requiring bone removal or flap elevation D0340 office visit - after regularly scheduled hours crown - full cast high noble metal administration of moderate sedation - intravenous - first 15 minute increment, or any portion thereof alveoloplasty in conjuction with extractions - four or more teeth or tooth spaces, per quadrant implant supported crown - porcelain fused to predominantly base alloys retainer crown - full cast predominantly base metal drugs or medicaments dispensed in the office for home use implant/abutment supported removable denture for partially edentulous arch - maxillary office visit for observation (during regularly scheduled hours) - no other services performed apicoectomy - anterior onlay - metallic - two surfaces retainer crown - resin with noble metal D8080 transseptal fiberotomy/supra crestal fiberotomy, by report D2530 implant supported crown - high noble alloys D0350 D1208 retainer crown - indirect resin based composite implant supported retainer for ceramic FPD D1206 surgical placement: eposteal implant immediate mandibular partial denture - flexible base (including any clasps, rests and teeth) pulp vitality tests retainer inlay - cast predominantly base metal, three or more surfaces replacement of lost or broken retainer - maxillary D2740 D2982 D0320 D2981 D4920 D0321 D0322 prefabricated esthetic coated stainless steel crown - primary tooth D2983 D2980 replacement of lost or broken retainer - mandibular incision and drainage of abscess - intraoral soft tissue consultation - diagnostic service provided by dentist or physician other than requesting dentist or physician connecting bar - implant supported or abutment supported D0330 D2751 D2750 comprehensive orthodontic treatment of the adolescent dentition D2753 D2510 D2752 D2991 inlay - metallic - three or more surfaces D6092 D6091 D8030 D6090 D9120 D6099 rebase complete maxillary denture D6098 D6097 removal of impacted tooth - partially bony D6094 D6093 removable unilateral partial denture – one piece flexible base (including retentive/clasping materials, rests, and teeth) – per quadrant D2720 retainer - cast metal for resin bonded fixed prosthesis lingual frenectomy (frenulectomy) crown - resin with predominantly base metal D2722 D2721 D8040 retainer crown - porcelain/ceramic incomplete endodontic therapy; inoperable, unrestorable or fractured tooth scaling and debridement of a single implant in the presence of peri-implantitis inflammation, bleeding upon probing and increased pocket depths, including cleaning of the implant surfaces, without flap entry and closure connector bar bitewing - single radiographic image D0310 adjustment - partial denture - maxillary other temporomandibular joint radiographic images, by report D2975 partial pulpotomy for apexogenesis - permanent tooth with incomplete root development D4910 D6070 D8010 palliative treatment of dental pain - per visit D6077 implant/abutment supported removable denture for edentulous arch - mandibular D6076 crown - resin-based composite (indirect) D6075 resin-based composite - three surfaces, anterior D6074 unscheduled dressing change (by someone other than treating dentist or their staff) D6073 D6072 D6071 removal of non-resorbable barrier in-office administration of minimal sedation - single drug - enteral D2940 apexification/recalcification - final visit (includes completed root canal therapy - apical closure/calcific repair of perforations, root resorption, etc.) removable unilateral partial denture - one piece cast metal (including retentive/clasping materials, rests, and teeth), maxillary D6069 D6068 gingival flap procedure, including root planing - four or more contiguous teeth or tooth bounded spaces per quadrant apicoectomy - molar (first root) D6081 D6080 D8020 repair resin partial denture base, maxillary D9110 D6088 D6087 excision of malignant tumor - lesion diameter up to 1.25 cm D6086 D6084 D6083 D6082 D2951 D2950 hospital or ambulatory surgical center call D2957 D2953 D2710 D2952 D2955 D2712 D2954 adjust complete denture - maxillary D2928 D2929 caries susceptibility tests D6056 D6055 comprehensive orthodontic treatment of the adult dentition D7140 D6050 therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament D6049 occlusal guard - hard appliance, partial arch D2920 implant supported retainer for FPD - porcelain fused to high noble alloys inlay - porcelain/ceramic - one surface D6067 D6066 localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth D6065 incisional biopsy of oral tissue - soft D6064 D6063 D6062 D6061 re-cement or re-bond implant/abutment supported fixed partial denture pedicle soft tissue graft procedure D6060 autogenous connective tissue graft procedure (including donor and recipient surgical sites) - each additional contiguous tooth, implant or edentulous tooth position in same graft site D6059 D6058 D6057 administration of nitrous oxide D2934 retainer onlay - titanium D2931 inlay - porcelain/ceramic - three or more surfaces D2930 implant supported retainer – porcelain fused to titanium and titanium alloys D2933 D2932 pontic - cast predominantly base metal D8210 D8695 guided tissue regeneration – resorbable barrier, per implant combined connective tissue and pedicle graft, per tooth re-cement or re-bond unilateral space maintainer - per quadrant pin retention - per tooth, in addition to restoration immediate maxillary partial denture - resin base (including retentive/clasping materials, rests and teeth) removal of benign nonodontogenic cyst or tumor - lesion diameter up to 1.25 cm D8220 D9310 retainer inlay - porcelain/ceramic, two surfaces repair broken complete denture base, maxillary replace missing or broken teeth - complete denture - per tooth pontic - porcelain fused to titanium and titanium alloys D6040 gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant D6280 rebase complete mandibular denture D8698 D2915 D8699 rebase hybrid prosthesis D2910 D8670 D7340 repair or replace broken retentive/clasping materials - per tooth abutment supported cast metal crown (predominantly base metal) D6010 D6252 D6251 D6250 removal of impacted tooth - completely bony tooth re-implantation and/or stabilization of accidentally evulsed or displaced tooth surgical repair of root resorption - anterior occlusal orthotic device, by report pulpal regeneration - interim medication replacement D6245 replacement of replaceable part of semi-precision or precision attachment of natural tooth borne prosthesis, per attachment vertical bitewings - 7 to 8 radiographic images surgical procedure for isolation of tooth with rubber dam removable unilateral partial denture - one piece cast metal (including retentive/clasping materials, rests, and teeth), mandibular surgical repair of root resorption - molar D8680 D7350 implant maintenance procedures when a full arch removable implant/abutment supported denture is removed and reinserted, including cleansing of prosthesis and abutments – per arch implant supported crown - predominantly base alloys bitewings - four radiographic images collection, preparation, and analysis of saliva sample – point-of-care comprehensive orthodontic treatment of the transitional dentition adjust maxillofacial prosthetic appliance, by report prefabricated stainless steel crown with resin window replacement of restorative material used to close an access opening of a screw-retained implant supported prosthesis, per implant D6013 pulpal debridement, primary and permanent teeth reduction of osseous tuberosity abutment supported retainer for porcelain fused to metal FPD (predominantly base metal) pontic - titanium and titanium alloys retainer onlay - cast noble metal, two surfaces D7320 D7321 periodontal scaling and root planing - four or more teeth per quadrant D5140 intraoral - occlusal radiographic image interim partial denture (including retentive/clasping materials, rests, and teeth), mandibular D4286 prophylaxis - adult retainer onlay - cast predominantly base metal, two surfaces D7311 3D facial surface scan - direct removal of impacted tooth - completely bony, with unusual surgical complications surgical reduction of fibrous tuberosity limited orthodontic treatment of the primary dentition D8660 D6243 D6242 D6241 D6240 prefabricated porcelain/ceramic crown - permanent tooth abutment supported porcelain fused to metal crown (predominantly base metal) testing for cracked tooth scaling and debridement of a single implant in the presence of mucositis, including inflammation, bleeding upon probing and increased pocket depths; includes cleaning of the implant surfaces, without flap entry and closure buccal/labial frenectomy (frenulectomy) D7540 D4273 D6210 pontic - porcelain fused to predominantly base metal D4274 D5120 retainer onlay - cast predominantly base metal, three or more surfaces application of caries arresting medication - per tooth D4270 incision and drainage of acscess - extraoral soft tissue D4268 D6205 D4266 D4267 D4264 D4265 interim complete denture (maxillary) D9952 D9951 retainer inlay - cast predominantly base metal, two surfaces D7310 D9971 tooth transplantation (includes re-implantation from one site to another and splinting and/or stabilization) D4285 D5130 D4283 prefabricated stainless steel crown - permanent tooth implant maintenance procedures when a full arch fixed hybrid prothesis is removed and reinserted, including cleansing of prosthesis and abutments D4277 D6214 removal of reaction producing foreign bodies, musculoskeletal system D4278 D4275 D6212 D4276 D6211 amalgam - four or more surfaces, primary or permanent retreatment of previous root canal therapy - molar re-cement or re-bond inlay, onlay, veneer or partial coverage restoration re-cement or re-bond implant/abutment supported crown