Employment and Community First (ECF) & 1915(c) Waiver Covered Codes

appliance removal (not by dentist who placed appliance), includes removal of archbar immediate mandibular partial denture - flexible base (including any clasps, rests and teeth) apexification/recalcification - initial visit (apical closure/calcific repair of perforations, root resorption, etc.) D7880 pulp vitality tests D6792 D6791 add metal substructure to acrylic complete denture - per arch D6548 D0322 tissue conditioning, maxillary D6545 D9939 D2980 D6784 D6783 precision attachment, by report D7510 pontic - resin with predominantly base metal incision and drainage of abscess - intraoral soft tissue D7997 stress breaker gingival flap procedure, including root planing - one to three contiguous teeth or tooth bounded spaces per quadrant retainer crown - 3/4 porcelain/ceramic D7530 trigeminal division block anesthesia D5228 apexification/recalcification - interim medication replacement D5227 removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue D5226 excision of hyperplastic tissue - per arch D5225 D9945 D9944 D9946 pontic - porcelain fused to noble metal D9243 D9244 D9245 D9246 rebase complete maxillary denture removal of impacted tooth - partially bony placement of a custom removable clear plastic temporary aesthetic appliance retainer - cast metal for resin bonded fixed prosthesis D4346 D7971 excision of periocoronal gingiva crown repair necessitated by restorative material failure D7972 D9910 D9239 D9911 retainer crown - porcelain/ceramic incomplete endodontic therapy; inoperable, unrestorable or fractured tooth D4240 D6782 D4241 D6781 administration of general anesthesia with advanced airway - each subsequent 15 minute increment, or any portion thereof intraoral tomosynthesis - comprehensive series of radiographic images connector bar overdenture - complete mandibular - natural tooth borne adjustment - partial denture - maxillary post removal immediate maxillary partial denture - flexible base (including any clasps, rests and teeth) D9247 reline mandibular partial denture (direct) D9920 D7282 local anesthesia not in conjunction with operative or surgical procedures diagnostic casts maxillary partial denture - flexible base (including retentive/clasping materials, rests, and teeth) D7285 D7286 D9222 D9223 extra-oral - 2D projection radiographic image created using a stationary radiation source, and detector D9224 D2390 crown - resin-based composite (indirect) D7280 decoronation or submergence of an erupted tooth 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.) D3353 D5411 D5410 D3351 D6740 core buildup, including any pins when required D3352 gingival flap procedure, including root planing - four or more contiguous teeth or tooth bounded spaces per quadrant D9215 mobilization of erupted or malpositioned tooth to aid eruption therapeutic parenteral drug, single administration apicoectomy - molar (first root) reline maxillary partial denture (indirect) D9219 interim complete denture (mandibular) D7970 D5671 D5670 excision of malignant tumor - lesion diameter up to 1.25 cm retreatment of previous root canal therapy - anterior D2951 D2950 prefabricated post and core in addition to crown D4211 D5422 repair broken complete denture base, mandibular D6753 D5421 D6752 retainer crown - full cast noble metal D6751 D4210 interim partial denture (including retentive/clasping materials, rests, and teeth), maxillary D2957 D9225 D2953 D2710 D2952 D2955 D2954 D3921 adjust complete denture - maxillary D7260 dental case management - patients with special health care needs retreatment of previous root canal therapy - premolar behavior management, by report retainer crown - resin with predominantly base metal D5877 D5876 therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament D3333 D5512 D6722 scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation D5511 D6721 D3331 incisional biopsy of oral tissue - hard (bone, tooth) D3332 apicoectomy (each additional root) D3450 occlusal guard - hard appliance, partial arch adjust complete denture - mandibular D7259 D5878 D7270 D7272 D9210 D9211 regional block anesthesia D9212 D6980 pontic - resin with noble metal replace all teeth and acrylic on cast metal framework (mandibular) incisional biopsy of oral tissue - soft tissue conditioning, mandibular D3346 D3347 D5765 D3221 D5520 D5761 placement of interim direct restoration D3220 D5760 excision of benign lesion up to 1.25 cm pontic - porcelain/ceramic D2933 D3348 precision attachment D2932 apicoectomy - premolar (first root) intraoral tomosynthesis - periapical radiographic image pontic - cast predominantly base metal D7240 D7241 application of desensitizing resin for cervical and/or root surface, per tooth internal root repair of perforation defects retainer crown - ¾ titanium and titanium alloys D0170 D3430 D5851 D6940 D5850 re-cement or re-bond fixed partial denture incision and drainage of abscess - intraoral soft tissue - complicated (includes drainage of multiple fascial spaces) pin retention - per tooth, in addition to restoration root amputation - per root removal of benign nonodontogenic cyst or tumor - lesion diameter up to 1.25 cm repair broken complete denture base, maxillary replace missing or broken teeth - complete denture - per tooth pontic - porcelain fused to titanium and titanium alloys evaluation for moderate sedation, deep sedation or general anesthesia gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant 2D cephalometric radiographic image - acquisition, measurement, and analysis rebase complete mandibular denture D5866 D5865 each additional prefabricated post - same tooth D5864 retrograde filling - per root D5863 D5741 D5862 D5740 D6950 intraoral tomosynthesis - bitewing radiographic image excision of benign lesion greater than 1.25 cm prefabricated resin crown rebase hybrid prosthesis retainer crown - 3/4 cast predominantly base metal D5867 removal of benign odontogenic cyst or tumor - lesion diameter up to 1.25 cm D7460 retainer crown - porcelain fused to titanium and titanium alloys local anesthesia in conjunction with operative or surgical procedures D6252 D6251 removal of impacted tooth - completely bony tooth re-implantation and/or stabilization of accidentally evulsed or displaced tooth administration of moderate sedation - enteral D5711 D3410 D5710 D6920 occlusal orthotic device, by report overdenture - complete maxillary - natural tooth borne gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quadrant 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 odontoplasty - per tooth D9997 overdenture - partial mandibular - natural tooth borne retainer crown - 3/4 cast noble metal exposure of an unerupted tooth mandibular partial denture - flexible base (including retentive/clasping materials, rests, and teeth) D7230 adjustment - partial denture - mandibular oroantral fistula closure reline maxillary partial denture (direct) D0277 prefabricated stainless steel crown with resin window D3421 D5721 D5720 D6930 treatment of root canal obstruction; non-surgical access D7465 pulpal debridement, primary and permanent teeth administration of deep sedation/general anesthesia - first 15 minute increment, or any portion thereof retainer crown - porcelain fused to predominantly base metal duplication of complete denture - maxillary D3425 D5725 D3426 D7440 post and core in addition to crown, indirectly fabricated fixed partial denture repair necessitated by restorative material failure nerve dissection retainer - porcelain/ceramic for resin bonded fixed prosthesis intraoral - occlusal radiographic image D5811 D5810 interim partial denture (including retentive/clasping materials, rests, and teeth), mandibular pontic - cast noble metal retainer crown - porcelain fused to noble metal D0240 D9610 duplication of complete denture - mandibular re-evaluation - limited, problem focused (established patient; not post-operative visit) removal of impacted tooth - completely bony, with unusual surgical complications surgical reduction of fibrous tuberosity D7450 each additional indirectly fabricated post - same tooth D9630 D6243 D6242 D6241 testing for cracked tooth D0374 D5821 occlusal guard - soft appliance, full arch D5820 overdenture - partial maxillary - natural tooth borne D0250 tomographic survey rebase mandibular partial denture D0251 D0372 D0373 D7511 destruction of lesion(s) by physical or chemical method, by report extra-oral posterior dental radiographic image administration of moderate sedation - intravenous - each subsequent 15 minute increment, or any portion thereof soft liner for complete or partial removable denture - indirect rebase maxillary partial denture administration of general anesthesia with advanced airway - first 15 minute increment, or any portion thereof D7540 administration of moderate sedation - non-intravenous parenteral – each subsequent 15 minute increment, or any portion thereof occlusal guard - hard appliance, full arch pontic - porcelain fused to predominantly base metal administration of moderate sedation - non-intravenous parenteral – first 15 minute increment, or any portion thereof replace all teeth and acrylic on cast metal framework (maxillary) administration of deep sedation/general anesthesia - each subsequent 15 minute increment, or any portion thereof D0460 D0340 D0461 interim complete denture (maxillary) D7410 D7413 administration of moderate sedation - intravenous - first 15 minute increment, or any portion thereof retainer crown - full cast predominantly base metal drugs or medicaments dispensed in the office for home use apicoectomy - anterior D9971 tooth transplantation (includes re-implantation from one site to another and splinting and/or stabilization) retainer crown - resin with noble metal reline mandibular partial denture (indirect) removal of reaction producing foreign bodies, musculoskeletal system application of desensitizing medicament D0470 D6212 resin-based composite crown, anterior D6211 retreatment of previous root canal therapy - molar