CoverKids Dental Covered Codes

Detailed and extensive oral eval-problem focused, by report Re-cement or re-bond unilateral space maintainer- per quadrant Interim partial denture-mandibular D7880 D4249 D5214 D6545 Buccal / labial frenectomy (frenulectomy) D5213 D5212 Pulpal debridement, primary and permanent teeth D5211 Apicoectomy - premolar (first root) D9930 Immediate denture - maxillary D7510 Crown-porcelain fused noble metal Re-cement or re-bond fixed partial denture D5110 D4263 D4260 D4381 Prophylaxis - child D4261 Resin-based composite - three surfaces, anterior Pulp cap - direct (excluding final restoration) D5228 Partial extraction for immediate implant placement D5227 D5226 D5225 Resin-based composite - one surface, posterior D7520 D9945 D9944 Treatment of complications (post-surgical) - unusual circumstances, by report Apicoectomy - molar (first root) Non-intravenous moderate sedation Removal of impacted tooth-partially bony Pin retention - per tooth, in addition to restoration Reline mandibular partial denture (chairside) Repair resin partial denture base, maxillary D4341 D4342 Space maintainer --removable--bilateral, mandibular Guided tissue regeneration, natural teeth – resorbable barrier, per site Occlusal orthotic device, by report D9910 D9911 Crown - full cast predominantly base metal D4355 Alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant Amalgam - four or more surfaces, primary or permanent Repair cast partial framework, maxillary Protective restoration Maxillary partial denture, resin base (including retentive/clasping materials, rests, and teeth) D2391 D5660 D2390 D3240 D2393 D2150 D2392 Apexification/recalcification - initial visit (apical closure / calcific repair of perforations, root resorption, etc.) D4323 D3353 D4322 D3230 D3351 D3472 D6740 D3110 D3352 D3473 D5650 Repair broken complete denture base, mandibular Intraoral - periapical each additional radiographic image D7953 D2160 Prophylaxis - adult D2161 Implant supported crown- porcelain fused to high noble alloys D4211 D2394 D6752 D3120 D6751 D4210 D6750 D7961 D7962 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) D5512 D5511 Re-evaluation, limited problem focused D3332 D5630 D5751 D5750 D3330 Reline complete mandibular denture (laboratory) Surgical repair of root resorption - anterior Incision and drainage of abscess - extraoral soft tissue Application of desensitizing resin for cervical and/or root surface, per tooth Apexification/recalcification - interim medication replacement Precision attachment Diagnostic casts Precision attachment, by report D3471 D2140 Apicoectomy (each additional root) D3346 D3347 D5765 D3221 D5520 D5640 D5761 D3220 D5760 Limited orthodontic treatment of the transitional dentition D3348 Crown - porcelain fused to noble metal Crown-porcelain fused high noble D0170 Immediate mandibular partial denture - flexible base (including any clasps, rests and teeth) Apicoectomy - anterior Pulpal therapy (resorbable filling) - posterior, primary tooth (excluding final restoration) D5612 Bone replacement graft - each additional site in quadrant D5611 D5731 D3430 D5730 D3310 D5850 Retainer - cast metal fixed Interim partial denture (maxillary) Re-cement or re-bond inlay, onlay, veneer or partial coverage restoration Surgical repair of root resorption – molar Interim crown Comprehensive periodontal evaluation - new or established patient D0180 Reline maxillary partial denture (laboratory) D5622 D5621 Crown - full cast high noble metal D3320 D5741 D5862 Crown - porcelain/ceramic Complete denture - mandibular D5740 D6950 Localized delivery of antimicrobial agents Surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated Occlusal guard--hard appliance, full arch Pulp vitality tests Add clasp to existing partial denture Soft liner for complete or partial removable denture – indirect D0270 D1354 D3410 Retainer crown, porcelain/ceramic D0140 D1110 D1351 2d oral/facial photographic image obtained intra-orally or extra-orally Incision and drainage of abscess - intraoral soft tissue Bone replacement graft - first site in quadrant D0160 Maxillary partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) D2332 D0277 D2335 D3421 D6930 D0150 D0272 D2331 D0274 D1120 D2330 Prefabricated stainless steel crown - primary tooth Radical excision - lesion diameter up to 1.25cm D3425 D5725 D3426 Reline complete maxillary denture (laboratory) Cephalometric radiographic image Hospital or ambulatory surgical center call Removable unilateral partial denture--one piece cast metal (including clasps and teeth), maxillary Resin-based composite - two surfaces, anterior Abutment supported retainer for porcelain fused to metal fpd (high noble metal) Occlusal guard--soft appliance full arch D0240 D0120 Amalgam - two surfaces, primary or permanent Retreatment of previous root canal therapy - premolar D0367 Reline complete mandibular denture (chairside) Crown - porcelain fused to predominantly base metal Amalgam - one surface, primary or permanent D5821 D5820 Topical application of fluoride varnish D2791 D2790 Application of desensitizing medicament D2792 Lingual frenectomy (frenulectomy) D2799 Incisional biopsy of oral tissue-hard (bone, tooth) Resin-based composite - four or more surfaces or involving incisal angle (anterior) D0220 D1552 Space maintainer --removable--bilateral, maxillary D1551 Resin-based composite - one surface, anterior D1553 Prefabricated resin crown Deep sedation/general anesthesia first 15 minutes D0460 D0340 Periodontal maintenance procedures Application of hydroxyapatite regeneration medicament – per tooth Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant Space maintainer-fixed, unilateral- per quadrant Reline mandibular partial denture (laboratory) D8080 Full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit Maxillary partial denture-flexible base Periodontal scaling and root planing - one to three teeth per quadrant D0470 D0350 D0230 D1208 Replace broken teeth-per tooth D1206 Occlusal adjustment - limited Abutment supported porcelain fused to metal crown (high noble metal) Placement of device to facilitate eruption of impacted tooth Endodontic therapy, molar tooth (excluding final restoration) D2740 Bitewings - two radiographic images D0321 Intravenous moderate (conscious) sedation/analgesia- first 15 minutes Therapeutic drug injection - 2 or more medications by report D2980 Resin-based composite - four or more surfaces, posterior Re-cement or re-bond crown D0330 D2751 D0210 D2750 D2752 D2991 Nerve dissection Panoramic radiographic image D8030 D9243 Other temporomandibular joint films, by report Bitewing - single radiographic image Bacteriologic studies Osseous surgery (including elevation of a full thickness flap and closure) - one to three contiguous teeth or tooth bounded spaces per quadrant D1510 Reline maxillary partial denture (chairside) D1516 D1517 D9239 Alveoloplasty not in conjunction with extractions - four or more teeth or tooth spaces, per quadrant Splint – extra-coronal; natural teeth or prosthetic crowns Custom abutment Cast post and core in addition to crown Re-cement or re-bond bilateral space maintainer-mandibular Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth Intraoral - comprehensive series of radiographic images Endodontic therapy, premolar tooth (excluding final restoration) Application of caries arresting medicament- per tooth D0431 Vertical bitewings - 7 to 8 films D1527 D1526 D9248 D4910 D6191 D7283 D7284 D7285 D7286 D9222 D9223 Core buildup, including any pins when required Surgical repair of root resorption – premolar D6192 D7280 Orthodontic retention (removal of appliances) D2940 Limited orthodontic treatment of the adolescent dentition D6069 Surgical removal of residual tooth roots (cutting procedure) Resin-based composite crown, anterior Pontic-porcelain fused-noble metal D8020 D9230 Removal of impacted tooth-soft tissue D9110 Tissue conditioning, maxillary Pulpal therapy (resorbable filling) - anterior, primary tooth (excluding final restoration) D2951 D2950 Mandibular partial denture-flexible base D0415 D2952 D2954 Immediate maxillary partial denture - flexible base (including any clasps, rests and teeth) Fixed appliance therapy (includes appliances for thumb sucking and tongue thrusting) Other drugs and/or medicaments, by report D2928 Space maintainer --fixed--bilateral, maxillary D6056 Sealant - per tooth D7140 Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament junction and application of medicament D7259 D2920 D7270 Splint – intra-coronal; natural teeth or prosthetic crowns Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignant and malignant lesions, not to include cytology or biopsy procedures Prefabricated stainless steel crown with resin window Comprehensive oral evaluation - new or established patient Osseous surgery (including elevation of a full thickness flap and closure) - four or more contiguous teeth or tooth bounded spaces per quadrant D6066 D6065 Repair resin partial denture base, mandibular Repair broken complete denture base, maxillary D6059 D6057 Crown repair, by report Resin-based composite - two surfaces, posterior D2931 D2930 D2933 D2932 D7240 D7241 Prefabricated stainless steel crown-permanent tooth D8210 D9420 Limited oral evaluation-problem focused Implant supported porcelain/ceramic crown Alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per quadrant Replace missing or broken teeth - complete denture (each tooth) Clinical crown lengthening - hard tissue Endodontic therapy, anterior tooth (excluding final restoration) Crown-porcelain fused to base metal Excisional biopsy of minor salivary glands Retrograde filling - per root Surgical placement of implant body: endosteal implant Crown - porcelain fused to high noble metal D7250 D7252 D8220 D9430 Inhalation of nitrous oxide/analgesia, anxiolysis Re-cement or re-bond bilateral space maintainer- maxillary Bitewings - four radiographic images Removable appliance therapy (includes appliances for thumb sucking and tongue thrusting) Retreatment of previous root canal therapy-anterior D2910 Reline complete maxillary denture (chairside) D8670 D7220 Therapeutic drug injection, by report Complete denture - maxillary Gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quadrant D6010 D5283 D5282 Periodic oral evaluation - established patient Topical application of fluoride - excluding varnish Periodontal scaling and root planing - four or more teeth per quadrant Pontic-porcelain fused-high noble Pontic-porcelain fused to base metal Palliative treatment of dental pain - per visit D8680 Mandibular partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) D7230 Surgical access of an unerupted tooth Intravenous moderate (conscious) sedation/analgesia - each subsequent 15 minute increment Semi-precision attachment – placement Incisional biopsy of oral tissue-soft D7320 Prefabricated porcelain/ceramic crown – permanent tooth D5140 Intraoral - occlusal radiographic image Pre-orthodontic treatment examination to monitor growth and development Rebase hybrid prosthesis Odontoplasty- per tooth, removal reshaping of enamel surfaces or projections. Resin-based composite - three surfaces, posterior Immediate denture - mandibular Removable unilateral partial denture--one piece cast metal (including clasps and teeth), mandibular Cone beam ct capture and interpretation with field of view of both jaws with or without cranium D7311 D9610 D9612 Retreatment of previous root canal therapy-molar Amalgam - three surfaces, primary or permanent D8660 D7210 D9630 D6242 D6241 D6240 Semi-precision abutment – placement Subepithelial connective tissue graft procedure Intraoral - periapical first radiographic image Bone replacement graft for ridge preservation - per site Prefabricated abutment Add tooth to existing partial denture Repair or replace broken retentive/clasping materials per tooth Comprehensive orthodontic treatment of the adolescent dentition D4273 D5120 Incomplete endodontic therapy; inoperable or fractured tooth Periodic orthodontic treatment visit D4266 D4264 Deep sedation/general anesthesia - each subsequent 15 minute increment D4265 Removal of impacted tooth-completely bony D7410 D9951 Repair cast partial framework, mandibular Prefabricated post and core in addition to crown D7310 D9971 Removal of impacted tooth-completely bony, with unusual surgical complications D5130 Space maintainer --fixed--bilateral, mandibular Pulp cap - indirect (excluding final restoration) Apexification/recalcification - final visit (includes completed root canal therapy - apical closure/calcific repair of perforations, root resorption, etc.) Crown - full cast noble metal Biological materials to aid in soft and osseous tissue regeneration per site Office visit for observation - no other services performed Mandibular partial denture, resin base (including retentive/clasping materials, rests, and teeth)