"D0120" "Periodic Or Oral Ev E v a lu a ti o n" " P e rE x " "/ X /" 0 "D0140" "Limited Oral Evaluation-Problem Focused" " Li m Ex " " /X / " 0 "D01 "D0150 50" " "Com "Compr preh ehen ensi sive ve Ora Oral l Eval Evalua uati tion on" " "CmpE "CmpEx" x" "/X/ "/X/" " 0 "D0160" "D0160" "Detailed "Detailed and Extensive Extensive oral Evaluation-P Evaluation-Problem roblem Focused, Focused, By Report" Report" "Det "Detai aile ledE dEva val" l" "/X/ "/X/" " 0 "D0170" "Re-evaluation - Limited, Problem Focused" " R eE v al " " /X / " 0 "D0180" "D0180" "Comprehensi "Comprehensive ve Periodontal Periodontal Examination Examination (New or Established Established Client)" "CompP "CompPeri erioEv oEval" al" "/X/" "/X/" 0 "D02 "D0210 10" " "Int "Intra raor oral al - Ful Full l Mou Mouth th X-ra X-rays ys (Inc (Inclu ludi ding ng Bite Bitewi wing ngs) s)" " "FMX "FMX" " "/X/ "/X/" " 0 "D0220" "Intraoral - 1 Pe Periapical XX-ray, Fi First Fi Film" " PA " " /X / " 0 "D0230" "Intraoral - Additional Periapical X-ray" " PA + " "/ X /" 0 "D0240" "Intraoral - Occlusal XX-ray" " O cc l us a lX " " / X/ " 0 "D0250" "Extraoral - First Film" " Ex t ra O r1 " "/ X / " 0 "D0260" "Extraoral - Each Additional Film" " Ex t ra O rX + " " / X/ " 0 "D0270" "1 Bitewing X-ray" "1 B W" " / X /" 0 "D0272" "2 Bitewing X-rays" " 2B W " " /X / " 0 "D0274" "4 Bitewing X-rays" " 4B W " " /X / " 0 "D0277" "Vertical Bitewings - 7 To 8 Films" " V er t BW 7 -8 " "/ X /" 0 "D0290" "A-P or Lateral Skull & Facial X-ray" " Su r vX r ay " " /X / " 0 " D 0 3 10 " " Si a lo g ra p hy " " S ia l o" " / X/ " 0 "D03 "D0320 20" " "TMJ "TMJ Join Joint t Art Arthr hrog ogra ram, m, incl includ udin ing g inj injec ecti tion on" " "TMJ "TMJAr Arth thrI rIni ninj nj" " "/X/ "/X/" " 0 "D0321" "Other TMJ Films, By Report" " O th e rT M JX " " / X/ " 0 "D0330" "Panoramic XX-ray" " P an o " " / X /" 0 "D0340" "Cephalometric Film" " C ep h al o " " / X/ " 0 "D03 "D0350 50" " "Ora "Oral/ l/Fa Faci cial al Imag Images es (Inc (Inclu lude ded d Int Intra ra and and Ext Extra raor oral al Imag Images es)" )" "Ora "OralF lFac ac i m a g e" "/ X /" 0 "D0415" "Microscopic Examination" " M ic r oE x " "/ X / " 0 "D0425" "Caries susceptibility tests" " C a ri e sT e st " " /X / " 0 "D0460" "Pulp Vitality Test" " P ul p Vi t a l " " /X / " 0 "D0470" "Diagnostic Casts" "D i ag n Ca s t " " / X/ " 0 "D0472" "D0472" "Accession "Accession of Tissue, Tissue, Gross Examination, Examination, Preparatio Preparation n and Transmission Transmission of Written Report" "A c ce s sT i ss G rE x " "/ X /" 0 "D0473" "D0473" "Accession "Accession of Tissue, Tissue, Gross and Microscopic Microscopic Examination Examination, , Preparation Preparation and
Transmission of Written Report" " Ac c es s Ti s sG r Mi c rE x " " /X / " 0 "D0474" "D0474" "Accession "Accession of Tissue, Tissue, Gross Examination, Examination, Including Including Assessment Assessment of Surgica Surgica l Margins for Presence of Disease, Preparation and Transmission of Written Repor t" " A cc e ss T i ss G rE x I nS u rg " " / X/ " 0 "D0480" "D0480" "Processing "Processing and Interpretati Interpretation on of Cytologic Smears, Smears, Including Preparatio Preparatio n an and Tr Transmission of of Wr Written Re Report" " P r o In t er O yt o Sm " "/ X /" 0 "D0502" "Other Oral Pathology Procedures, By Report" " Ot h er P at h " "/ X /" 0 "D09 "D0999 99" " "Uns "Unspe peci cifi fied ed Diag Diagno nost stic ic Proc Proced edur ure, e, By Repo Report rt" " "Uns "Unspe pecD cDia iagn gn" " "/X/ "/X/" " 0 "D1110" "Cleaning-Adult (Transitional or Permanent Teeth)" " Pr o " "/ X /" 0 "D1120" "Cleaning-Child (P (Primary or or Tr Transitional Te Teeth)" " Pr o C hi l d " " /X / " 0 "D1201" "Topical Fluoride Including Prophy-Child" " Pr o Fl o C hi ld " " / X/ " 0 "D1203" "Fluoride To Topical Ex Excluding Pr Prophy-Child" " Fl o Ch i l d" " / X/ " 0 "D1204" "Fluoride Topical Excluding Prophy-Adult" " Fl o " "/ X /" 0 "D1205" "Topical Fluoride Including Prophy-Adult" " Pr o Fl o " "/ X /" 0 "D1310 "D1310" " "Nutri "Nutritio tional nal Counse Counselin ling g for for Contro Control l of Dental Dental Diseas Disease" e" "Nutri "NutriCns Cnsl" l" " /X / " 0 "D1320" "Tobacco Co C ou n s el i n g" " T ob a co C n s l" " / X/ " 0 "D1330" "Oral Hygiene Instruction" " O r al H yg I n" "/ X /" 0 "D1351" "Sealant (p (per to t o o t h) " "S e al " " /X / " 0 "D1510" "Space Ma Maintainer-Fixed-Unilateral" " B an d Lo o p" " / X/ " 0 "D1515" "Space Maintainer-Fixed-Bilateral" " Sp M Fx B i" "/ X / " 0 "D15 "D1520 20" " "Spa "Space ce Main Mainta tain iner er-R -Rem emov ovab able le-U -Uni nila late tera ral" l" "SpM "SpMRe RemU mUni ni" " "/X/ "/X/" " 0 "D1525" "Space Maintainer-Removable-Bilater teral" "SpMRemBil" "/ X/ " 0 "D1550" "Recementation of Space Maintainer" " R ec e me n t" " / X/ " 0 "D2140" "Amalgam-One Surface, Primary or Permanent" "A 1 " " /X / " 0 "D2150" "Amalgam-Two Surfaces, Primary or Permanent" " A2 " " /X / " 0 "D2160" "Amalgam-Three Sur Surfaces, Pri Primary or Pe Permanent" "A3" " /X / " 0 "D2161" "Amalgam-Four or or Mo More Su Surfaces, Pr Primary or or Pe Permanent" "A 4 " " / X/ " 0 "D2330" "Composite 1 Surface-Anterior" "C1" " /X / " 0 "D2331" "Composite 2 Surfaces-Anterior" "C2 "C2" " / X/ " 0 "D2332" "Composite 3 Surfaces-Anterior" "C3 "C3" " / X/ " 0 "D23 "D2335 35" " "Com "Compo posi site te 4 Or More More Surf Surfac aces es-A -Ant nter erio ior" r" "C4" "C4" "/X/ "/X/" " 0 "D2390" "Composite Resin Crown-Anterior" " C re s Cn " " /X / "
0 "D2391" "Composite 1 Surface-Posterior" "C1(P)" "/X/" 0 "D2392" "Composite 2 Surfaces-Posterior" "C2(P)" "/X/" 0 "D2393" "Composite 3 Surfaces-Posterior" "C3(P)" "/X/" 0 "D2394" "Composite 4 Or More Surfaces-Posterior" "C4(P)" "/X/" 0 "D2410" "Gold Foil 1 Surface" "GoldFoil1" "/X/" 0 "D2420" "Gold Foil 2 Surfaces" "GoldFoil2" "/X/" 0 "D2430" "Gold Foil 3 Surfaces" "GoldFoil3" "/X/" 0 "D2510" "Inlay-Metallic-1 Surface" "InlayMet1" "/X/" 0 "D2520" "Inlay-Metallic-2 Surfaces" "InlayMet2" "/X/" 0 "D2530" "Inlay-Metallic-3 Surfaces" "InlayMet3" "/X/" 0 "D2542" "Onlay-Metallic-2 Surfaces" "OnlayMet2" "/X/" 0 "D2543" "Onlay-Metallic-3 Surfaces" "OnlayMet3" "/X/" 0 "D2544" "Onlay-Metallic-4 or More Surfaces" "OnlayMet4" "/X/" 0 "D2610" "Inlay-Porcelain/Ceramic-1 Surface" "CerInlay1" "/X/" 0 "D2620" "Inlay-Porcelain/Ceramic-2 Surfaces" "Cerinlay2" "/X/" 0 "D2630" "Inlay-Porcelain/Ceramic-3 Surfaces" "Cerinlay3" "/X/" 0 "D2642" "Onlay-Porcelain/Ceramic-2 Surfaces" "CerOnlay2" "/X/" 0 "D2643" "Onlay-Porcelain/Ceramic-3 Surfaces" "CerOnlay3" "/X/" 0 "D2644" "Onlay-Porcelain/Ceramic-4 or More Surfaces" "Ceronlay4" "/X/" 0 "D2650" "Inlay-Composite/Resin-1 Surface" "InCRs1Lb" "/X/" 0 "D2651" "Inlay-Composite/Resin-2 Surfaces" "InCRs2Lb" "/X/" 0 "D2652" "Inlay-Composite/Resin-3 Surfaces" "InCRs3Lb" "/X/" 0 "D2662" "Onlay-Composite/Resin-2 Surfaces" "OnCRs2S" "/X/" 0 "D2663" "Onlay-Composite/Resin-3 Surfaces" "OnCRs3S" "/X/" 0 "D2664" "Onlay-Composite/Resin-4 or More Surfaces" "OnCRs4+S" "/X/" 0 "D2710" "Crown-Resin-Indirect (Fiber, Porcelain, or Ceramic Reinforced Polymer)" "CrnRsLb" "/X/" 0 "D2720" "Crown-Resin with High Noble Metal" "CrnRsHN" "/X/" 0 "D2721" "Crown-Resin with Predominantly Base Metal" "CrnRsBm" "/X/" 0 "D2722" "Crown-Resin with Noble Metal" "CrnRsNm" "/X/" 0
"D2740" 0 "D2750" 0 "D2751" "/X/" "D2752" 0 "D2780" 0 "D2781" 0 "D2782" 0 "D2783" 0 "D2790" 0 "D2791" 0 "D2792" 0 "D2799" n" "D2910" 0 "D2920" 0 "D2930" "/X/" "D2931" "/X/" "D2932" 0 "D2933" "/X/" "D2940" 0 "D2950" 0 "D2951" 0 "D2952" 0 "D2953" 0 "D2954" 0 "D2955" ov" "D2957" "/X/" "D2960" 0 "D2961" 0 "D2962" 0 "D2970" 0
"Crown-All Porcelain/Ceramic"
"AllCerCrn"
"/X/"
"Crown-Porcelain Fused to High Noble Metal"
"PFM"
"Crown-Porcelain Fused to Predominantly Base Metal"
"/X/"
"Crown-Porcelain Fused to Noble Metal"
"CrnPrFNm"
"CrnPrFBm" 0 "/X/"
"Crown-3/4 Cast High Noble Metal"
"3/4HiNobl"
"/X/"
"Crown-3/4 Cast Predominantly Base Metal"
"3/4BaseM"
"Crown-3/4 Cast Noble Metal"
"3/4Noble"
"/X/"
"Crown-3/4 Porcelain/Ceramic"
"3/4Porc"
"/X/"
"Crown-Full Cast High Noble Metal"
"FGCrn" "/X/"
"Crown-Full Cast Predominantly Base Metal"
"CrnFlcBm"
"Crown-Full Cast Noble Metal"
"/X/"
"CrnFlcNm"
"Provisional Crown (Interim Restoration Of At Least 6 Months)" "/X/" "Recement Inlay" "RecemInly" "/X/" "Recement Crown"
"RecemCn"
"/X/"
"ProvisC 0
"/X/"
"Prefabricated Stainless Steel Crown-Primary Tooth" "Prefabricated Stainless Steel Crown-Permanent Tooth" "Prefabricated Resin Crown"
"/X/"
"PrFbRsCrn"
"SSCPri" 0 "SSCPer" 0
"/X/"
"Prefabricated Stainless Steel Crown with Resin Window" "PrFbScRsW" 0 "Sedative Filling" "SedFill" "/X/" "Crore Build Up, Including Any Pins "
"BU"
"/X/"
"Pin Retention-Per Tooth, In Addition to Restoration"
"Pin"
"/X/"
"Cast Post and Core in Addition to Crown"
"CastP&C"
"Each Additional Cast Post - Same Tooth"
"AdditCastPost" "/X/"
"Prefabricated Post and Core in Addition to Crown"
"P&C"
"/X/"
"/X/"
"Post Removal (not in conjunction with endodontic therapy)" "PostRem "/X/" 0 "Each Additional Prefabricated Post - Same Tooth" "AdditPost" 0 "Labial Veneer (resin laminate)-Chairside" "CmpVnr" "/X/" "Labial Veneer (resin laminate)-Laboratory"
"CmpVnrLb"
"Labial Veneer (porcelain laminate)-Laboratory" "PorcVnr" "Temporary Crown (fractured tooth)"
"TempCrn"
"/X/"
"/X/" "/X/"
"D2980" "Crown Repair, by Report" "CrnRepair" "/X/" 0 "D2999" "Unspecified Restorative Procedure, by Report" "UnspecRestor" "/X/" 0 "D3110" "Pulp Cap - Direct (excluding final restoration)" "PulpCap" "/X/" 0 "D3120" "Pulp Cap - Indirect (excluding final restoration)" "PulpCapIn" "/X/" 0 "D3220" "Therapeutic Pulpotomy (excluding final restoration)" "Pulpotomy" "/X/" 0 "D3221" "Pulpal Debridement-Primary and Permanent Teeth " "PulpDebr" "/X/" 0 "D3230" "Root Canal, (resorbable filling) - Anterior, Primary Tooth (excluding f inal restoration)" "PulpThA/Pr" "/X/" 0 "D3240" "Root Canal, (resorbable filling) - Posterior, Primary Tooth (excluding final restoration)" "PulpThP/Pr" "/X/" 0 "D3310" "Root Canal, Anterior" "RCTAnt" "/X/" 0 "D3320" "Root Canal, Bicuspid" "RCTPre" "/X/" 0 "D3330" "Root Canal, Molar" "RCTMol" "/X/" 0 "D3331" "Treatment of Root Canal Obstruction; Non-Surgical Access" "RCObstr " "/X/" 0 "D3332" "Incomplete Endodontic Therapy; Inoperable or Fractured Tooth" "IncmpRC T" "/X/" 0 "D3233" "Internal Root Repair of Perforation Defects (Not Iatrogenic by Provider Filing Claim)" "InternRRepair" "/X/" 0 "D3346" "Retreatment-Anterior" "RCT-RAnt" "/X/" 0 "D3347" "Retreatment-Bicuspid" "RCT-RBi" "/X/" 0 "D3348" "Retreatment-Molar" "RCT-RMol" "/X/" 0 "D3351" "Apexification/Recalcification-Initial Visit" "Apexif" "/X/" 0 "D3352" "Apexification/Recalcification-Interim Visit" "ApxRclIn" "/X/" 0 "D3353" "Apexification/Recalcification-Final Visit" "ApxRcFin" "/X/" 0 "D3410" "Apicoectomy/Periradicular Surgery-Anterior" "ApctPrSrA" "/X/" 0 "D3421" "Apicoectomy/Periradicular Surgery-Bicuspid (first root)" "ApctPr+ th" "/X/" 0 "D3425" "Apicoectomy/Periradicular Surgery-Molar (first root)" "ApctPrMol" "/X/" 0 "D3426" "Apicoectomy/Periradicular Surgery (each additional root)" "ApctPr+ th" "/X/" 0 "D3430" "Retrograde Filling-Per Root" "RetroFill" "/X/" 0 "D3450" "Root Amputation-Per Root" "RtAmp" "/X/" 0 "D3460" "Endodontic Endosseous Implant" "EndoEdsIm" "/X/" 0 "D3470" "Intentional Replantation (Including Necessary Splinting)" "IntRplI Sp" "/X/" 0 "D3910" "Surgical Procedure for Isolation of Tooth with Rubber Dam" "SurgIs/
RD" "/X/" 0 "D3920" "Hemisection (including any root removal, not root canal)" "Hemi" "/X/" 0 "D3950" "Canal Preparation For Post" "CanPrepPt" "/X/" 0 "D3999" "Unspecified Endodontic Procedure, by Report" "UnspecEndo" "/X/" 0 "D4210" "Gingivectomy/plasty-Four or More Contiguous Teeth or Bounded Teeth Spac es" "GingivQdr" "/X/" 0 "D4211" "Gingivectomy/plasty-One to Three Teeth, per Quadrant" "Gingiv" "/X/" 0 "D4240" "Gingival Flap Procedure, Including Root Planing-Four or More Contiguous Teeth or Bounded Teeth Spaces" "GnFlInRtp4+" "/X/" 0 "D4241" "Gingival Flap Procedure, Including Root Planing-One to Three Teeth, per Quadrant" "GnFlInRtp1-3" "/X/" 0 "D4245" "Apically Positioned Flap" "ApicFlap" "/X/" 0 "D4249" "Crown Lengthening-Hard Tissue" "CrnLength" "/X/" 0 "D4250" "Mucogingival Surgery-per Quadrant" "MucGinSrQ" "/X/" 0 "D4260" "Osseous Surgery-Four or More Contiguous Teeth or Bounded Teeth Spaces" "OssSurgQ" "/X/" 0 "D4261" "Osseous Surgery-One to Three Teeth, per Quadrant" "OssSurg1-2" "/X/" 0 "D4263" "Bone Replacement Graft-First Site in Quadrant" "BnRpGr1st" "/X/" 0 "D4264" "Bone Replacement Graft-Each Additional Site in Quadrant" "BnRpGrE a1+" "/X/" 0 "D4265" "Biologic Materials to Aid in Soft and Osseous Tissue Regeneration" "BioMatSftOTissReg" "/X/" 0 "D4266" "Guided Tissue Regeneration-Resorbable Barrier, Per Site" "TissRgP er" "/X/" 0 "D4267" "Guided Tissue Regeneration-Non-resorbable Barrier, Per Site, Per Tooth" "TissRgNr" "/X/" 0 "D4268" "Surgical Revision Procedure, Per Tooth" "SurgRevis" "/X/" 0 "D4270" "Pedicle Soft Tissue Graft Procedure" "PedSfTsGr" "/X/" 0 "D4271" "Free Soft Tissue Graft Procedure" "FrSfTsGr" "/X/" 0 "D4273" "Subepithelial Connective Tissue Graft" "SubTsGr" "/X/" 0 "D4274" "Distal or Proximal Wedge Procedure" "DistPxWg" "/X/" 0 "D4275" "Soft Tissue Allograft" "SfTsAll" "/X/" 0 "D4276" "Combined Connective Tissue and Double Pedicle Graft" "ComConTissDPGr" "/X/" 0 "D4320" "Provisional Splint-Intracoronal" "ProSplIn" "/X/" 0 "D4321" "Provisional Splint-Extracoronal" "ProSplEx" "/X/" 0 "D4341" "Periodontal Scaling and Root Planing-Four or More Contiguous Teeth or B
ounded Teeth Spaces" "SRP" "/X/" 0 "D4342" "Periodontal Scaling and Root Planing-One to Three Teeth, per Quadrant" "SRP1-3" "/X/" 0 "D4355" "Full Mouth Debridement to Enable Comprehensive Periodontal Evaluation a nd Diagnosis" "FMDebride" "/X/" 0 "D4381" "Localized Delivery of Chemotherapeutic Agents Via A Controlled Release Vehicle" "Arestin" "/X/" 0 "D4910" "Periodontal Maintenance, Following Active Therapy (Surgical or Non-Surg ical)" "PerioMaint" "/X/" 0 "D4920" "Unscheduled Dressing Change (Other Than Treating Dentist)" "UnscDrC hg" "/X/" 0 "D4999" "Unspecified Periodontal Procedure, by Report" "UnspecPerio" "/X/" 0 "D5110" "Complete Upper Denture" "MaxDent" "/X/" 0 "D5120" "Complete Lower Denture" "MandDent" "/X/" 0 "D5130" "Immediate-Complete Upper Denture" "MaxImmDent" "/X/" 0 "D5140" "Immediate-Complete Lower Denture" "MandImmDent" "/X/" 0 "D5211" "Upper Partial Denture - Resin" "PermMaxFlip" "/X/" 0 "D5212" "Lower Partial Denture - Resin" "PermMandFlip" "/X/" 0 "D5213" "Upper Partial Denture - Cast Metal With Resin Denture Base" "MaxRPD" "/X/" 0 "D5214" "Lower Partial Denture - Cast Metal With Resin Denture Base" "MandRPD " "/X/" 0 "D5281" "Removable Unilateral Partial Denture - One Piece Cast Metal" "RmvUniP Dn" "/X/" 0 "D5410" "Adjust Complete Upper Denture" "AdjCmDnMax" "/X/" 0 "D5411" "Adjust Complete Lower Denture" "AdjCmDnMand" "/X/" 0 "D5421" "Adjust Partial Denture Upper" "AdjPrDnMax" "/X/" 0 "D5422" "Adjust Partial Denture Lower" "AdjPrDnMand" "/X/" 0 "D5510" "Repair Broken Complete Denture Base" "RepairDent" "/X/" 0 "D5520" "Replace Missing or Broken Teeth-Complete Denture (each tooth)" "RplThCm Dn" "/X/" 0 "D5610" "Partial Denture Repair, Resin Base" "ReprRPDRsBs" "/X/" 0 "D5620" "Partial Denture Repair, Cast Framework" "ReprFlip" "/X/" 0 "D5630" "Partial Denture Repair or Replace Broken Clasp" "ReprClasp" "/X/" 0 "D5640" "Partial Denture Replace Broken Teeth, Per Tooth" "ReplBrkTth" "/X/" 0 "D5650" "Add Tooth To Existing Partial Denture" "AddTooth" "/X/" 0 "D5660" "Add Clasp To Existing Partial Denture" "AddClasp" "/X/" 0
"D5670" "Replace All Teeth and Acrylic on Cast Metal Framework (Maxillary)" "ReTh&AcryMaxRPD" "/X/" 0 "D5671" "Replace All Teeth and Acrylic on Cast Metal Framework (Mandibular)" "ReTh&AcryMandRPD" "/X/" 0 "D5710" "Rebase Complete Upper Denture" "RebsComMaxDn" "/X/" 0 "D5711" "Rebase Complete Lower Denture" "RebsComMandDn" "/X/" 0 "D5720" "Rebase Upper Partial Denture" "RebsRPDMaxDn" "/X/" 0 "D5721" "Rebase Lower Partial Denture" "RebsRPDMandDn" "/X/" 0 "D5730" "Reline Complete Upper Denture (chairside)" "RelMaxDntChair" "/X/" 0 "D5731" "Reline Complete Lower Denture (chairside)" "RelMandDntChair" "/X/" 0 "D5740" "Reline Upper Partial Denture (chairside)" "RelMaxRPDChair" "/X/" 0 "D5741" "Reline Lower Partial Denture (chairside)" "RelMandRPDChair" "/X/" 0 "D5750" "Reline Complete Upper Denture (lab)" "RelMaxDnLab" "/X/" 0 "D5751" "Reline Complete Lower Denture (lab)" "RelMandDnLab" "/X/" 0 "D5760" "Reline Upper Partial Denture (lab)" "RelMaxRPDLab" "/X/" 0 "D5761" "Reline Lower Partial Denture (lab)" "RelMandRPDLab" "/X/" 0 "D5810" "Interim Complete Denture Upper" "TempCompMaxDn" "/X/" 0 "D5811" "Interim Complete Denture Lower" "TempCompMandDn" "/X/" 0 "D5820" "Interim Partial Denture Upper" "TempMaxFlip" "/X/" 0 "D5821" "Interim Partial Denture Lower" "TempMandFlip" "/X/" 0 "D5850" "Tissue Conditioning, Upper" "TisConMax" "/X/" 0 "D5851" "Tissue Conditioning, Lower" "TisConMand" "/X/" 0 "D5860" "Overdenture-Complete, by Report" "OverDent" "/X/" 0 "D5861" "Overdenture-Partial, by Report" "OverDentRPD" "/X/" 0 "D5862" "Precision Attachment, by Report" "DentAttach" "/X/" 0 "D5867" "Replacement of Replaceable Part of Semi-Precision Attachment (Male or F emale Component)" "ReplDnAttach" "/X/" 0 "D5875" "Modification of Removable Prosthesis Following Implant Surgery" "ModRmvProAftImpSurg" "/X/" 0 "D5899" "Unspecified Removable Prosthodontic Procedure, by Report" "UnspecD ent" "/X/" 0 "D5911" "Facial Moulage (sectional)" "SecFacMoul" "/X/" 0 "D5912" "Facial Moulage (complete)" "CompFacMoul" "/X/" 0
"D5913" 0 "D5914" 0 "D5915" 0 "D5916" 0 "D5919" 0 "D5922" 0 "D5923" 0 "D5924" 0 "D5925" 0 "D5926" 0 "D5927" 0 "D5928" 0 "D5929" 0 "D5931" 0 "D5932" 0 "D5933" 0 "D5934" "/X/" "D5935" "/X/" "D5936" 0 "D5937" 0 "D5951" 0 "D5952" 0 "D5953" 0 "D5954" 0 "D5955" 0 "D5958" 0 "D5959" 0 "D5960" 0 "D5982" 0 "D5983" 0
"Nasal Prosthesis"
"NasPros"
"/X/"
"Auricular Prosthesis"
"AurPros"
"/X/"
"Orbital Prosthesis"
"OrbPros"
"/X/"
"Ocular Prosthesis"
"OcuPros"
"/X/"
"Facial Prosthesis"
"FacPros"
"/X/"
"Nasal Septal Prosthesis"
"NasSepPros"
"/X/"
"Ocular Prosthesis, Interim"
"TempOcuPros"
"/X/"
"Cranial Prosthesis"
"CranPros"
"/X/"
"Facial Augmentation Implant Prosthesis"
"FacAugImp"
"Nasal Prosthesis, Replacement" "NasProsRep"
"/X/"
"Auricular Prosthesis, Replacement"
"AurProsRep"
"/X/"
"Orbital Prosthesis, Replacement"
"OrbProsRep"
"/X/"
"Facial Prosthesis, Replacement"
"FacProsRep"
"/X/"
"Obturator Prosthesis, Surgical"
"ObtProsSur"
"/X/"
"Obturator Prosthesis, Definitive"
"ObtProsDef"
"/X/"
"Obturator Prosthesis, Modification"
"ObtProsMod"
"/X/"
"Mandibular Resection Prosthesis with Guide Flange" "Mandibular Resection Prosthesis without Guide Flange"
"MandResFla" 0 "MandRec" 0
"Obturator Prosthesis, Interim" "ObtProsInt"
"/X/"
"Trismus Appliance (not for TMD treatment)"
"TrisAppli"
"Feeding Aid"
"FeedAid"
"/X/"
"Speech Aid Prosthesis, Pediatric" "Speech Aid Prosthesis, Adult"
"SpchAidPd"
"SpchAidAd"
"/X/"
"/X/"
"Palatal Augmentation Prosthesis"
"PalAugPros"
"/X/"
"Palatal Lift Prosthesis, Definitive"
"PiLftProsDf"
"/X/"
"Palatal Lift Prosthesis, Interim"
"PiLftProsIn"
"/X/"
"Palatal Lift Prosthesis, Modification" "PiLftProsMod"
"/X/"
"/X/"
"Speech Aid Prosthesis, Modification"
"SpchAdProsMod" "/X/"
"Surgical Stent"
"SurgStent"
"/X/"
"Radiation Carrier"
"RadtnCarr"
"/X/"
"/X/"
"D5984" "Radiation Shield" "RadtnShld" "/X/" 0 "D5985" "Radiation Cone Locator" "RadtnCnLc" "/X/" 0 "D5986" "Fluoride Gel Carrier" "FlrGelCarr" "/X/" 0 "D5987" "Commissure Splint" "CommSplnt" "/X/" 0 "D5988" "Surgical Splint" "SurgSplnt" "/X/" 0 "D5999" "Unspecified Maxillofacial Prosthesis, by Report" "UnspecMaxPros" "/X/" 0 "D6010" "Surgical Placement of Implant Body: Endosteal Implant" "SurgImpEnd" "/X/" 0 "D6020" "Abutment Placement or Substitution: Endosteal Implant" "PlaceAbut" "/X/" 0 "D6040" "Surgical Placement Eposteal Implant" "SurgEpoImp" "/X/" 0 "D6050" "Surgical Placement Transosteal Implant" "SurgTranImp" "/X/" 0 "D6053" "Implant/Abutment Supported Removable Denture for Completely Edentulous Arch" "ImpAvRmvDnCpEdA" "/X/" 0 "D6054" "Implant/Abutment Supported Removable Denture for Partially Edentulous A rch" "ImpAbRmvDnPartEdA" "/X/" 0 "D6055" "Dental Implant Supported Connecting Bar" "ImpConBr" "/X/" 0 "D6056" "Prefabricated Abutment" "PrefabAbut" "/X/" 0 "D6057" "Custom Abutment (e.g. UCLA abutment)" "CustAbut" "/X/" 0 "D6058" "Abutment Supported Porcelain/Ceramic Crown" "AbPorCerCn" "/X/" 0 "D6059" "Abutment Supported Porcelain Fused to Metal Crown, High Noble Metal" "AbPFMCnHNM" "/X/" 0 "D6060" "Abutment Supported Porcelain Fused to Metal Crown, Predominantly Base M etal" "AbPFMCnBasM" "/X/" 0 "D6061" "Abutment Supported Porcelain Fused to Metal Crown, Noble Metal" "AbPFMCnNM" "/X/" 0 "D6062" "Abutment Supported Cast Metal Crown, High Noble Metal" "AbCasMCnHNM" "/X/" 0 "D6063" "Abutment Supported Cast Metal Crown, Predominantly Base Metal" "AbCasMC nBasM" "/X/" 0 "D6064" "Abutment Supported Cast Metal Crown, Noble Metal" "AbCasMCnNM" "/X/" 0 "D6065" "Implant Supported Porcelain/Ceramic Crown" "ImpPorCerCn" "/X/" 0 "D6066" "Implant Supported Porcelain Fused to Metal Crown (Titanium, Titanium Al loy, High Noble Metal)" "ImpPFMCrn" "/X/" 0 "D6067" "Implant Supported Metal Crown (Titanium, Titanium Alloy, High Noble Met al)" "ImpMCn" "/X/" 0 "D6068" "Abutment Supported Retainer for Porcelain/Ceramic Fixed Partial Denture " "AbCasMCnBasM" "/X/" 0
"D6069" "Abutment Supported Retainer for Porcelain Fused to Metal Fixed Partial Denture, High Noble Metal" "AbRPFMFxRPDHNM" "/X/" 0 "D6070" "Abutment Supported Retainer for Porcelain Fused to Metal Fixed Partial Denture, Predominantly Base Metal" "AbRPFMFxRPDBasM" "/X/" 0 "D6071" "Abutment Supported Retainer for Porcelain Fused to Metal Fixed Partial Denture, Noble Metal" "AbRPFMFxRPDNM" "/X/" 0 "D6072" "Abutment Supported Retainer for Cast Metal Fixed Partial Denture, High Noble Metal" "AbRtCasMFxRPDHNM" "/X/" 0 "D6073" "Abutment Supported Retainer for Cast Metal Fixed Partial Denture, Predo minantly Base Metal" "AbRCasMFxRPDBasM" "/X/" 0 "D6074" "Abutment Supported Retainer for Cast Metal Fixed Partial Denture, Noble Metal" "AbRCasMFxRPDNM" "/X/" 0 "D6075" "Implant Supported Retainer for Ceramic Fixed Partial Denture" "ImpRCer FxRPD" "/X/" 0 "D6076" "Implant Supported Retainer for Porcelain Fused to Metal Fixed Partial D enture (Titanium, Titanium Alloy, or High Noble Metal)" "ImpRPFMFxRPD" "/X/" 0 "D6077" "Implant Supported Retainer for Cast Metal Fixed Partial Denture (Titani um, Titanium Alloy, or High Noble Metal)" "ImpRCasMFxRPD" "/X/" 0 "D6078" "Implant/Abutment Supported Fixed Denture for Completely Edentulous Arch " "ImpAbFxDnCpEden" "/X/" 0 "D6079" "Implant/Abutment Supported Fixed Denture for Partially Edentulous Arch" "ImpAbFxDnPartEden" "/X/" 0 "D6080" "Implant Maintenance Procedures" "ImplMaint" "/X/" 0 "D6090" "Repair Implant Supported Prosthesis, by Report" "RepairProsth" "/X/" 0 "D6095" "Repair Implant Abutment, By Report" "RepairAbut" "/X/" 0 "D6100" "Implant Removal, by Report" "ImpRmv" "/X/" 0 "D6199" "Unspecified Implant Procedure, by Report" "Unspeclmpl" "/X/" 0 "D6210" "Pontic-Cast High Noble Metal" "PontCast" "/X/" 0 "D6211" "Pontic-Cast Predominantly Base Metal" "PontCastBasM" "/X/" 0 "D6212" "Pontic-Cast Noble Metal" "PontCastNM" "/X/" 0 "D6240" "Pontic-Porcelain Fused to High Noble Metal" "Bridge" "/X/" 0 "D6241" "Pontic-Porcelain Fused to Predominantly Base Metal" "BridgePontic" "/X/" 0 "D6242" "Pontic-Porcelain Fused to Noble Metal" "PontPFNM" "/X/" 0 "D6245" "Pontic-Porcelain/Ceramic" "PorcPontic" "/X/" 0 "D6250" "Pontic-Resin with High Noble Metal" "PntcRsHNM" "/X/" 0 "D6251" "Pontic-Resin with Predominantly Base Metal" "PntcRsRdB" "/X/" 0
"D6252" "Pontic-Resin with Noble Metal" "PntcRsNM" "/X/" 0 "D6253" "Pontic-Provisional (6 months or more)" "ProvisPontic" "/X/" 0 "D6545" "Bridge retainer-Cast Metal for Resin Bonded Bridge" "MaryBridge" "/X/" 0 "D6548" "Bridge retainer-Porcelain/Ceramic for Resin Bonded Bridge" "PorcRet " "/X/" 0 "D6600" "Bridge retainer-Inlay-Porcelain/Ceramic-2 Surfaces" "BrdgRetInPor2S" "/X/" 0 "D6601" "Bridge retainer-Inlay-Porcelain/Ceramic-3 or More Surfaces" "BrdgRet InPor3+S" "/X/" 0 "D6602" "Bridge retainer-Inlay-Cast High Noble Metal-2 Surfaces" "BrdgRet InCasHNM2S" "/X/" 0 "D6603" "Bridge retainer-Inlay-Cast High Noble Metal-3 or More Surfaces" "BrdgRetInCasHNM3+S" "/X/" 0 "D6604" "Bridge retainer-Inlay-Cast Predominantly Base Metal-2 Surfaces" "BrdgRetInCasHNM2S" "/X/" 0 "D6605" "Bridge retainer-Inlay-Cast Predominantly Base Metal-3 or More Surfaces" "BrdgRetInCasBsM3+S" "/X/" 0 "D6606" "Bridge retainer-Inlay-Cast Noble Metal-2 Surfaces" "BrdgRetInCasNM2 S" "/X/" 0 "D6607" "Bridge retainer-Inlay-Cast Noble Metal-3 or More Surfaces" "BrdgRet InCasNM3+S" "/X/" 0 "D6608" "Bridge retainer-Onlay-Porcelain/Ceramic-2 Surfaces" "BrdgRetOnPor2S" "/X/" 0 "D6609" "Bridge retainer-Onlay-Porcelain/Ceramic-3 or More Surfaces" "BrdgRet OnPor3+S" "/X/" 0 "D6610" "Bridge retainer-Onlay-Cast High Noble Metal-2 Surfaces" "BrdgRet OnCasHNM2S" "/X/" 0 "D6611" "Bridge retainer-Onlay-Cast High Noble Metal-3 or More Surfaces" "BrdgRetOnCasHNM3+S" "/X/" 0 "D6612" "Bridge retainer-Onlay-Cast Predominantly Base Metal-2 Surfaces" "BrdgRetOnCasBsM2S" "/X/" 0 "D6613" "Bridge retainer-Onlay-Cast Predominantly Base Metal-3 or More Surfaces" "BrdgRetOnCasBsM3+S" "/X/" 0 "D6614" "Bridge retainer-Onlay-Cast Noble Metal-2 Surfaces" "BrdgRetOnCasNM2 S" "/X/" 0 "D6615" "Bridge retainer-Onlay-Cast Noble Metal-3 or More Surfaces" "BrdgRet RsHNM" "/X/" 0 "D6720" "Bridge retainer-Resin with High Noble Metal" "RtCrnRsHN" "/X/" 0 "D6721" "Bridge retainer-Resin with Predominantly Base Metal" "RtCrnRsBM" "/X/" 0 "D6722" "Bridge retainer-Resin with Noble Metal" "RtCrnRsNM" "/X/" 0 "D6740" "Bridge retainer-Porcelain/Ceramic" "CrnPorBr" "/X/" 0 "D6750" "Bridge retainer-Porcelain Fused to High Noble Metal" "BrdgRetPorFHNM"
"/X/" "D6751" end)" "D6752" "/X/" "D6780" 0 "D6781" "/X/" "D6782" 0 "D6783" 0 "D6790" 0 "D6791" "/X/" "D6792" 0 "D6793" "/X/" "D6920" 0 "D6930" 0 "D6940" 0 "D6950" 0 "D6970" "/X/" "D6971" 0 "D6972" r+B" "D6973" "/X/" "D6975" 0 "D6976" 0 "D6977" "/X/" "D6980" 0 "D6985" "/X/" "D6999" "/X/" "D7111" 0 "D7140" 0 "D7210" 0 "D7220" 0 "D7230" 0 "D7240"
0 "Bridge retainer-Porcelain Fused to Predominantly Base Metal" "Bridge( "/X/" 0 "Bridge retainer-Porcelain Fused to Noble Metal" "RtCrnPrFN" 0 "Bridge retainer-3/4 Cast High Noble Metal" "RtCrn3/4" "/X/" "Bridge retainer-3/4 Cast Predominantly Base Metal" "Bridge retainer-3/4 Cast Noble Metal"
"3/4CrnNob"
"Bridge retainer-3/4 Porcelain/Ceramic" "3/4Porc" "Bridge retainer-Full Cast High Noble Metal"
"Bridge retainer-Full Cast Noble Metal" "RtFCastNM" "Bridge retainer-Provisional (6 Months or More)" "/X/"
"Recement Bridge"
"RecemBrdg"
"/X/"
"Stress Breaker"
"StressBrk"
"/X/"
"Precision Attachment"
"PrecAttach"
"/X/"
"/X/"
"RtCrnFCHN"
"Bridge retainer-Full Cast Predominantly Base Metal"
"Connector Bar" "Bar"
"3/4Base" 0 "/X/"
"/X/"
"RtFCastBasM" 0 "/X/" "ProvisRt" 0
"Cast Post and Core in Addition to Bridge retainer" "Cast Post as Part of Bridge retainer"
"CstPtCr+B" 0 "CstPtBrdgeRet" "/X/"
"Prefabricated Post and Core in Addition to Bridge retainer" "PrfbPtC "/X/" 0 "Core Build-up for Bridge retainer, Including Any Pins" "CrBURtIP" 0 "Coping-Metal" "Coping" "/X/" "Each Additional Cast Post - Same Tooth"
"CastPtAdd"
"Each Additional Prefabricated Post - Same Tooth" "Bridge Repair, by Report"
"BrdgRepair"
"/X/"
"PreFbPtAdd" 0
"/X/"
"Pediatric Bridge (Primarily for Esthetic Reasons)"
"PedoBrdg" 0 "Unspecified Fixed Prosthodontic Procedure, by Report" "UnspFxProsth" 0 "Extraction, Primary Tooth-Coronal Remnants" "E-Prim" "/X/" "Extraction, Erupted Tooth or Exposed Root" "Extraction, Surgical"
"E-Surg"
"E"
"/X/"
"/X/"
"Extraction Impacted Tooth-Soft Tissue" "E-SoftTiss"
"/X/"
"Extraction Impacted Tooth-Partial Bony"
"E-PartBony"
"/X/"
"Extraction Impacted Tooth-Complete Bony"
"E-CompBony"
"/X/"
0 "D7241" "Extraction Impacted Tooth-Complete Bony, Complications" "E-Bonyw Complic" "/X/" 0 "D7250" "Surgical Removal of Residual Roots" "SurgRmvResidR" "/X/" 0 "D7260" "Oral Antral Fistula Closure" "OrAntFistClos" "/X/" 0 "D7261" "Primary Closure of a Sinus Perforation" "PrimClosSinusPerfor" "/X/" 0 "D7270" "Tooth Reimplantation and/or Stabilization of Accidentally Evulsed or Di splaced Tooth" "ToothReimplant/Stabili" "/X/" 0 "D7272" "Tooth Transplantation" "ToothTransplant" "/X/" 0 "D7280" "Surgical Access of Unerupted Tooth (may include, but not limited to pla cement of attachment for eruption)" "SurgAccessUnerupt" "/X/" 0 "D7281" "Surgical Exposure of Tooth to Aid Eruption" "SurgExposAidErupt" "/X/" 0 "D7282" "Mobilization of Erupted or Malpositioned Tooth to Aid Eruption" "MobErup/MalposAidErup" "/X/" 0 "D7285" "Biopsy of Oral Tissue-Hard (bone, tooth)" "BiopsyOralTissH" "/X/" 0 "D7286" "Biopsy of Oral Tissue-Soft (all others)" "BiopsySoft" "/X/" 0 "D7287" "Cytology Sample Collection" "OytologySampCol" "/X/" 0 "D7290" "Surgical Repositioning of Teeth" "SurgReposition" "/X/" 0 "D7291" "Transseptal Fiberotomy, By Report" "TransFibero" "/X/" 0 "D7310" "Alveoloplasty in Conjunction with Extractions-per Quadrant" "Alveolo -w/E" "/X/" 0 "D7320" "Alveoloplasty not in Conjunction with Extractions-per Quadrant" "Alveolo-w/oE" "/X/" 0 "D7340" "Vestibuloplasty-Ridge Extension (Secondary Epithelialization)" "/X/" 0 "D7350" "Vestibuloplasty-Ridge Extension (Grafts, Muscles, Etc.)" "/X/" 0 "D7410" "Excision of Benign Lesion Diameter Up To 1.25 cm" "/X/" 0 "D7411" "Excision of Benign Lesion Diameter Greater Than 1.25 cm" "/X/" 0 "D7412" "Excision of Benign Lesion, Complicated" "/X/" 0 "D7413" "Excision of Malignant Lesion Diameter Up To 1.25 cm" "/X/" 0 "D7414" "Excision of Malignant Lesion Diameter Greater Than 1.25 cm" "/X/" 0 "D7415" "Excision of Malignant Lesion, Complicated" "/X/" 0 "D7465" "Destruction of Lesion(s) by Physical or Chemical Methods, by Report" "/X/" 0 "D7440" "Excision of Malignant Tumor-Lesion Diameter up to 1.25 cm" "/X/" 0 "D7441" "Excision of Malignant Tumor-Lesion Diameter Greater than 1.25 cm" "/X/" 0
"D7450" "Removal of Benign Odontogenic Cyst/Tumor-Lesion Diameter up to 1.25 cm" "/X/" 0 "D7451" "Removal of Benign Odontogenic Cyst/Tumor-Lesion Diameter Greater than 1 .25 cm" "/X/" 0 "D7460" "Removal of Benign Nonodontogenic Cyst/Tumor-Lesion Diameter up to 1.25 cm" "/X/" 0 "D7461" "Removal of Benign Nonodontogenic Cyst/Tumor-Lesion Diameter Greater tha n 1.25 cm" "/X/" 0 "D7471" "Removal of Lateral Exostosis-Maxilla or Mandible" "/X/" 0 "D7472" "Removal of Torus Palatinus" "/X/" 0 "D7473" "Removal of Torus Mandibularis" "/X/" 0 "D7485" "Surgical Reduction of Osseous Tuberosity" "/X/" 0 "D7490" "Radical Resection of Mandible with Bone Graft" "/X/" 0 "D7510" "Incision And Drainage Of Abscess-Intraoral Soft Tissue" "Inc&Dra in" "/X/" 0 "D7520" "Incision And Drainage Of Abscess-Extraoral Soft Tissue" "/X/" 0 "D7530" "Removal of Foreign Body, Skin, or Subcutaneous Alveolar Tissue" "/X/" 0 "D7540" "Removal of Reaction-Producing Foreign Bodies-Musculoskeletal System" "/X/" 0 "D7550" "Partial Ostectomy/Sequestrectomy for Removal of Non-Vital Bone" "/X/" 0 "D7560" "Maxillary Sinusotomy for Removal of Tooth Fragment or Foreign Body" "/X/" 0 "D7610" "Maxilla-Open Reduction (teeth immobilized if present)" "/X/" 0 "D7620" "Maxilla-Closed Reduction (teeth immobilized if present)" "/X/" 0 "D7630" "Mandible-Open Reduction (teeth immobilized if present)" "/X/" 0 "D7640" "Mandible-Closed Reduction (teeth immobilized if present)" "/X/" 0 "D7650" "Malar and/or Zygomatic Arch-Open Reduction" "/X/" 0 "D7660" "Malar and/or Zygomatic Arch-Closed Reduction" "/X/" 0 "D7670" "Alveolus-Closed Reduction, May Include Stabilization of Teeth" "/X/" 0 "D7671" "Alveolus-Open Reduction, May Include Stabilization of Teeth" "/X/" 0 "D7680" "Facial Bones-Complicated Reduction with Fixation, Multiple Surgical App roaches" "/X/" 0 "D7710" "Maxilla-Open Reduction" "MaxOpReduc" "/X/" 0 "D7720" "Maxilla-Closed Reduction" "MaxClosReduc" "/X/" 0 "D7730" "Mandible-Open Reduction" "MandOpReduc" "/X/" 0 "D7740" "Mandible-Closed Reduction" "MandClosReduc" "/X/" 0
