Dental Reimbursement Rates in Arkansas

D0210 — Full Mouth X-Rays D0310 — Sialography D0372 — Cone Beam CT — 3D Data Capture (Both Jaws) D0320 — TMJ Arthrogram D0322 — Tomographic Survey D0340 — 2D Cephalometric X-Ray D0330 — Panoramic X-Ray D0396 — 3D Volume Rendering of Image Data D0417 — Collection of Saliva for Lab Analysis D0426 — Caries Risk Assessment & Documentation (Low Risk)

D1516 — Space Maintainer — Fixed, Bilateral (Maxillary) D1517 — Space Maintainer — Fixed, Bilateral (Mandibular) D1575 — Distal Shoe Space Maintainer D1206 — Fluoride Varnish Treatment D1510 — Space Maintainer — Fixed, Unilateral D1557 — Removal of Fixed Space Maintainer (Bilateral, Max)

D2921 — Reattachment of Tooth Fragment D2150 — Amalgam Filling — 2 Surfaces, Primary/Permanent D2644 — Onlay — Porcelain/Ceramic, 4+ Surfaces D2642 — Onlay — Porcelain/Ceramic, 2 Surfaces D2543 — Onlay — Metallic, 3 Surfaces D2710 — Crown — Resin (Indirect) D2920 — Re-cement/Re-bond Crown D2390 — Composite Crown — Anterior, Primary D2662 — Onlay — Composite/Resin, 2 Surfaces D2955 — Post Removal D2931 — Prefabricated Stainless Steel Crown — Permanent D2331 — Composite Filling — 2 Surfaces, Anterior D2962 — Labial Veneer — Porcelain (Lab) D2530 — Inlay — Metallic, 3+ Surfaces D2643 — Onlay — Porcelain/Ceramic, 3 Surfaces D2664 — Onlay — Composite/Resin, 4+ Surfaces D2981 — Inlay Repair, By Report D2982 — Onlay Repair, By Report D2650 — Inlay — Composite/Resin, 1 Surface D2720 — Crown — Resin with High Noble Metal D2791 — Crown — Full Cast Base Metal D2934 — Prefabricated Esthetic Coated SS Crown — Primary D2953 — Post and Core — Each Additional (Cast) D2542 — Onlay — Metallic, 2 Surfaces D2544 — Onlay — Metallic, 4+ Surfaces D2610 — Inlay — Porcelain/Ceramic, 1 Surface D2630 — Inlay — Porcelain/Ceramic, 3+ Surfaces D2651 — Inlay — Composite/Resin, 2 Surfaces D2663 — Onlay — Composite/Resin, 3 Surfaces D2722 — Crown — Resin with Noble Metal D2750 — Crown — Porcelain Fused to High Noble Metal D2930 — Prefabricated Stainless Steel Crown — Primary D2950 — Core Buildup Including Pins D2954 — Prefabricated Post and Core D2960 — Labial Veneer — Resin (Chair-side) D2961 — Labial Veneer — Resin (Lab) D2980 — Crown Repair, By Report D2983 — Veneer Repair, By Report D2160 — Amalgam Filling — 3 Surfaces, Primary/Permanent D2161 — Amalgam Filling — 4+ Surfaces, Primary/Permanent D2330 — Composite Filling — 1 Surface, Anterior D2335 — Composite Filling — 4+ Surfaces/Incisal Angle D2391 — Composite Filling — 1 Surface, Posterior D2392 — Composite Filling — 2 Surfaces, Posterior D2393 — Composite Filling — 3 Surfaces, Posterior D2410 — Gold Foil — 1 Surface D2420 — Gold Foil — 2 Surfaces D2510 — Inlay — Metallic, 1 Surface D2520 — Inlay — Metallic, 2 Surfaces D2652 — Inlay — Composite/Resin, 3+ Surfaces D2721 — Crown — Resin with Base Metal D2740 — Crown — Porcelain/Ceramic D2751 — Crown — Porcelain Fused to Base Metal D2780 — Crown — ¾ Cast High Noble Metal D2783 — Crown — ¾ Porcelain/Ceramic D2794 — Crown — Titanium D2799 — Provisional Crown D2929 — Prefabricated Porcelain/Ceramic Crown — Permanent D2957 — Each Additional Prefabricated Post D2976 — Stump Buildup with Pins

D3450 — Root Amputation — Per Root D3331 — Treatment of Root Canal Obstruction (Non-Surgical) D3428 — Retrograde Filling — Per Root D3222 — Partial Pulpotomy for Apexogenesis — Permanent D3501 — Surgical Exposure for Canal Access D3502 — Surgical Perforation Repair D3351 — Apexification/Recalcification — Initial Visit D3220 — Therapeutic Pulpotomy (Excluding Final Restoration) D3333 — Internal Root Repair — Perforation D3310 — Root Canal — Anterior (Excluding Final Restoration) D3320 — Root Canal — Premolar (Excluding Final Restoration) D3330 — Root Canal — Molar (Excluding Final Restoration) D3346 — Retreatment — Anterior D3347 — Retreatment — Premolar D3357 — Pulpal Regeneration — Final Visit D3429 — Hemisection (Including Root Removal, Not Crown) D3432 — Guided Tissue Regeneration (Periradicular Surgery) D3473 — Surgical Repair — Root Resorption (Molar) D3503 — Surgical Root Repair — Anterior D3230 — Pulpal Therapy — Anterior, Primary D3332 — Incomplete Endodontic Treatment (Inoperable/Fracture) D3348 — Retreatment — Molar D3410 — Apicoectomy — Anterior D3421 — Apicoectomy — Premolar (First Root) D3426 — Apicoectomy — Each Additional Root D3431 — Biologically-Based Root Treatment D3471 — Surgical Repair — Root Resorption (Anterior) D3472 — Surgical Repair — Root Resorption (Premolar) D3920 — Hemisection (Not Root Canal/Restoration) D3921 — Decoronation/Intentional Submergence D3240 — Pulpal Therapy — Posterior, Primary D3353 — Apexification/Recalcification — Final Visit D3425 — Apicoectomy — Molar (First Root) D3470 — Intentional Reimplantation D3950 — Canal Prep and Fitting of Preformed Post/Dowel

D4241 — Gingival Flap Surgery — 1–3 Teeth (Per Quad) D4210 — Gingivectomy/Gingivoplasty — 4+ Teeth (Per Quad) D4240 — Gingival Flap Surgery — 4+ Teeth (Per Quad) D4274 — Distal/Proximal Wedge Procedure D4230 — Anatomical Crown Exposure — 4+ Teeth (Per Quad) D4245 — Apically Positioned Flap D4249 — Clinical Crown Lengthening — Hard Tissue D4355 — Full Mouth Debridement D4231 — Anatomical Crown Exposure — 1–3 Teeth (Per Quad) D4260 — Osseous Surgery — 4+ Teeth (Per Quad) D4261 — Osseous Surgery — 1–3 Teeth (Per Quad) D4266 — Guided Tissue Regeneration — Resorbable Barrier D4267 — Guided Tissue Regeneration — Non-Resorbable Barrier D4275 — Non-Autogenous Connective Tissue Graft (First Tooth) D4286 — Combined Connective Tissue Graft (Each Add'l Tooth) D4323 — Splint — Extracoronal (Natural Teeth) D4341 — Scaling and Root Planing — 4+ Teeth (Per Quad) D4211 — Gingivectomy/Gingivoplasty — 1–3 Teeth (Per Quad) D4212 — Gingivectomy/Gingivoplasty (Restorative, Per Tooth) D4263 — Bone Replacement Graft — First Site (Per Quad) D4285 — Non-Autogenous Connective Tissue Graft (Each Add'l) D4322 — Splint — Intracoronal (Natural Teeth) D4342 — Scaling and Root Planing — 1–3 Teeth (Per Quad) D4346 — Scaling — Generalized Moderate/Severe Gingivitis D4910 — Periodontal Maintenance

D5640 — Replace Broken Teeth — Per Tooth D5731 — Reline Complete Lower Denture (Chair-side) D5730 — Reline Complete Upper Denture (Chair-side) D5821 — Interim Partial Lower Denture D5811 — Interim Complete Lower Denture D5286 — Removable Unilateral Partial Denture — 2 Piece (Metal) D5865 — Overdenture — Complete (Implant Supported) D5214 — Lower Partial Denture — Cast Metal Framework D5710 — Rebase Complete Upper Denture D5741 — Reline Lower Partial Denture (Chair-side) D5877 — Replacement of Locator Male, By Report D5213 — Upper Partial Denture — Cast Metal Framework D5223 — Immediate Upper Partial Denture — Cast Metal D5511 — Repair Broken Complete Denture Base (Upper) D5512 — Repair Broken Complete Denture Base (Lower) D5670 — Replace Teeth & Acrylic on Metal Framework D5671 — Replace All Teeth & Acrylic on Cast Metal Framework D5740 — Reline Upper Partial Denture (Chair-side) D5760 — Reline Upper Partial Denture (Lab) D5810 — Interim Complete Upper Denture D5820 — Interim Partial Upper Denture D5862 — Precision Attachment — By Report D5140 — Immediate Lower Denture D5212 — Lower Partial Denture — Resin Base (w/ Clasps/Rests) D5222 — Immediate Lower Partial Denture — Resin Base D5225 — Upper Partial Denture — Flexible Base D5284 — Removable Unilateral Partial Denture — 1 Piece (Flex) D5612 — Repair Resin Partial Denture Base (Lower) D5761 — Reline Lower Partial Denture (Lab) D5850 — Tissue Conditioning (Upper) D5851 — Tissue Conditioning (Lower) D5863 — Overdenture — Complete (Implant/Root Supported) D5864 — Overdenture — Partial (Implant/Root Supported) D5878 — Add Wrought Wire Clasp (Tooth-Supported) D5120 — Complete Lower Denture D5211 — Upper Partial Denture — Resin Base (w/ Clasps/Rests) D5221 — Immediate Upper Partial Denture — Resin Base D5226 — Lower Partial Denture — Flexible Base D5227 — Immediate Upper Partial Denture — Flexible Base D5282 — Removable Unilateral Partial Denture — 1 Piece (Metal) D5283 — Removable Unilateral Partial Denture — 1 Piece (Resin) D5410 — Adjust Complete Upper Denture D5421 — Adjust Partial Upper Denture D5422 — Adjust Partial Lower Denture D5520 — Replace Missing/Broken Teeth — Complete Denture D5611 — Repair Resin Partial Denture Base (Upper) D5621 — Repair Cast Partial Framework (Upper) D5622 — Repair Cast Partial Framework (Lower) D5711 — Rebase Complete Lower Denture D5721 — Rebase Lower Partial Denture D5750 — Reline Complete Upper Denture (Lab) D5751 — Reline Complete Lower Denture (Lab) D5765 — Soft Liner for Complete or Partial Denture D5867 — Replacement of Attachment — Implant Overdenture

D6107 — Bone Graft — From Extra-Oral Donor Site D6084 — Custom Implant Abutment (Porcelain/Ceramic) D6065 — Implant Crown — Porcelain/Ceramic D6074 — Implant Bridge Pontic — Porcelain/Ceramic D6602 — Bridge Retainer — Inlay, Cast High Noble Metal (2 Surf) D6055 — Dental Implant-Supported Connecting Bar D6612 — Bridge Retainer — Onlay, Cast Base Metal (2 Surf) D6615 — Bridge Retainer — Onlay, Cast Noble Metal (3+ Surf) D6098 — Implant-Supported Retainer (Removable) D6110 — Implant Bridge Retainer — Porcelain Fused to HNM D6252 — Bridge Pontic — Resin with Noble Metal D6603 — Bridge Retainer — Inlay, Cast High Noble Metal (3+ Surf) D6080 — Implant Maintenance — Cleaning/Inspection D6113 — Implant Bridge Retainer — Cast Metal (HNM) D6750 — Bridge Retainer — Porcelain Fused to High Noble Metal D6076 — Implant Crown — Base Metal D6250 — Bridge Pontic — Resin with High Noble Metal D6549 — Retainer — Resin for Resin-Bonded Bridge D6073 — Implant Bridge Pontic — Cast High Noble Metal D6087 — Implant Bridge Pontic — Resin D6092 — Re-cement/Re-bond Implant Crown D6103 — Bone Graft — Implant Repair (First Site) D6123 — Implant-Supported Retainer — FPD (Titanium) D6545 — Retainer — Cast Metal for Resin-Bonded Bridge D6613 — Bridge Retainer — Onlay, Cast Base Metal (3+ Surf) D6051 — Interim Implant Abutment D6066 — Implant Crown — Porcelain Fused to Metal D6068 — Implant Abutment — Prefabricated D6072 — Implant Bridge Pontic — Porcelain Fused to Metal D6083 — Implant-Supported Prosthesis Repair, By Report D6086 — Implant Crown — Resin D6111 — Implant Bridge Retainer — Porcelain Fused to BM D6121 — Implant-Supported Retainer — FPD (Noble) D6192 — Semi-Precision Abutment — Removal D6195 — Implant-Supported Connector Bar (Modification) D6601 — Bridge Retainer — Inlay, Porcelain/Ceramic (3+ Surf) D6608 — Bridge Retainer — Onlay, Porcelain/Ceramic (2 Surf) D6609 — Bridge Retainer — Onlay, Porcelain/Ceramic (3+ Surf) D6614 — Bridge Retainer — Onlay, Cast Noble Metal (2 Surf) D6753 — Bridge Retainer — Porcelain Fused to Titanium D6793 — Bridge Retainer — Full Cast Titanium D6010 — Surgical Placement — Endosteal Implant Body D6011 — Second Stage Implant Surgery D6012 — Surgical Placement — Interim Implant Body D6013 — Surgical Placement — Mini Implant D6050 — Custom Fabricated Implant Abutment D6057 — Custom Fabricated Implant Abutment D6071 — Implant Crown — Cast Base Metal D6075 — Implant Crown — Porcelain Fused to Titanium D6077 — Implant Crown — Noble Metal D6082 — Implant-Supported Crown Repair, By Report D6091 — Implant Repair — Abutment Replacement D6104 — Bone Graft — Implant Repair (Each Add'l Site) D6122 — Implant-Supported Retainer — FPD (Base) D6242 — Bridge Pontic — Porcelain Fused to Noble Metal D6251 — Bridge Pontic — Resin with Base Metal D6600 — Bridge Retainer — Inlay, Porcelain/Ceramic (2 Surf) D6606 — Bridge Retainer — Inlay, Cast Noble Metal (2 Surf) D6610 — Bridge Retainer — Onlay, Cast High Noble Metal (2 Surf) D6611 — Bridge Retainer — Onlay, Cast High Noble Metal (3+ Surf) D6781 — Bridge Retainer — ¾ Cast Base Metal D6782 — Bridge Retainer — ¾ Cast Noble Metal D6790 — Bridge Retainer — Full Cast High Noble Metal D6980 — Fixed Partial Denture Repair, By Report D6040 — Surgical Placement — Eposteal Implant D6058 — Implant Abutment — Prefabricated D6060 — Implant Abutment — Prefabricated (Noble Metal) D6061 — Implant Abutment — Prefabricated (Base Metal) D6062 — Implant Abutment — Cast-to (Noble Metal) D6067 — Implant Crown — High Noble Metal D6070 — Implant Crown — Cast High Noble Metal D6085 — Provisional Implant Crown D6088 — Implant Bridge Retainer — Resin D6089 — Implant Abutment Modification D6093 — Re-cement/Re-bond Implant Bridge D6097 — Abutment-Supported Retainer (Removable) D6099 — Implant-Supported Retainer for FPD (Ceramic) D6101 — Debridement of Peri-Implant Defect — Surgical D6102 — Bone Graft — Debridement of Peri-Implant Defect D6106 — Bone Graft — Mandibular Symphysis D6112 — Implant Bridge Retainer — Porcelain/Ceramic D6180 — Implant-Supported Partial Denture (Upper) D6210 — Bridge Pontic — Cast High Noble Metal D6240 — Bridge Pontic — Porcelain Fused to High Noble Metal D6604 — Bridge Retainer — Inlay, Cast Base Metal (2 Surf) D6605 — Bridge Retainer — Inlay, Cast Base Metal (3+ Surf) D6607 — Bridge Retainer — Inlay, Cast Noble Metal (3+ Surf) D6710 — Bridge Retainer — Indirect Resin D6720 — Bridge Retainer — Resin with High Noble Metal D6721 — Bridge Retainer — Resin with Base Metal D6783 — Bridge Retainer — ¾ Porcelain/Ceramic D6784 — Bridge Retainer — ¾ Titanium D6950 — Precision Attachment

D7310 — Alveoloplasty — With Extractions (Per Quad) D7251 — Coronectomy — Intentional Partial Tooth Removal D7287 — Exfoliative Cytological Sample Collection D7450 — Removal of Benign Odontogenic Cyst ≤ 1.25 cm D7321 — Alveoloplasty — Without Extractions (1–3 Teeth) D7285 — Incisional Biopsy — Oral Tissue (Hard) D7994 — Surgical Placement — Bone-Fixation Plate D7350 — Vestibuloplasty — Ridge Extension (w/ Graft) D7520 — Incision and Drainage — Extraoral (Soft Tissue) D7252 — Tooth Removal of Impacted Tooth (Soft Tissue) D7472 — Removal of Torus Palatinus D7880 — Occlusal Orthotic Device — By Report D7220 — Extraction — Soft Tissue Impacted Tooth D7230 — Extraction — Partially Bony Impacted Tooth D7270 — Tooth Reimplantation/Stabilization D7272 — Tooth Transplantation D7286 — Incisional Biopsy — Oral Tissue (Soft) D7290 — Surgical Repositioning of Teeth D7320 — Alveoloplasty — Without Extractions (Per Quad) D7451 — Removal of Benign Odontogenic Cyst > 1.25 cm D7510 — Incision and Drainage — Intraoral (Soft Tissue) D7957 — Guided Bone Regeneration — Non-Resorbable Membrane D7210 — Extraction — Surgical (Erupted Tooth) D7280 — Surgical Exposure of Impacted Tooth (Orthodontic) D7471 — Removal of Lateral Exostosis D7509 — Marsupialization of Cyst D7511 — Incision and Drainage — Intraoral (Soft Tissue, Complicated) D7881 — Occlusal Orthotic Device — Adjustment D7953 — Bone Replacement Graft — Ridge Preservation D7140 — Extraction — Erupted Tooth or Exposed Root D7240 — Extraction — Completely Bony Impacted Tooth D7241 — Extraction — Completely Bony Impacted (Complicated) D7250 — Extraction — Residual Root Removal D7261 — Primary Closure of Sinus Perforation D7282 — Mobilization of Erupted/Malpositioned Tooth D7283 — Placement of Device for Eruption of Impacted Tooth D7296 — Corticotomy — One to Three Tooth Spaces D7297 — Corticotomy — Four or More Tooth Spaces D7340 — Vestibuloplasty — Ridge Extension D7411 — Excision of Benign Lesion > 1.25 cm D7413 — Excision of Malignant Lesion ≤ 1.25 cm D7910 — Suture of Wound (Up to 5 cm) D7956 — Guided Bone Regeneration — Edentulous Area D7961 — Buccal/Labial Frenectomy D7962 — Lingual Frenectomy D7970 — Excision of Hyperplastic Tissue — Per Arch D7971 — Excision of Pericoronal Gingiva

D8699 — Re-cement/Re-bond Fixed Retainer, By Report D8702 — Replacement of Lost/Broken Retainer (Removable)

D9410 — House/Extended Care Facility Call D9910 — Application of Desensitizing Medicament D9952 — Occlusal Adjustment — Complete D9230 — Inhalation Analgesia (Nitrous Oxide) D9245 — Non-IV Moderate Conscious Sedation — First 15 min D9612 — Therapeutic Parenteral Drug — Two+ Administrations D9972 — External Bleaching — Per Arch D9110 — Palliative (Emergency) Treatment D9224 — Deep Sedation/General Anesthesia — First 15 min (Dentist) D9244 — Non-IV Moderate Conscious Sedation (By Non-Treating Dentist) D9246 — Non-IV Moderate Conscious Sedation — Each Add'l 15 min D9247 — Non-IV Moderate Conscious Sedation — Supplemental D9310 — Consultation — Specialist/Dentist D9420 — Hospital or ASC Call D9610 — Therapeutic Parenteral Drug — Single Admin D9613 — Infiltration of Sustained-Release Therapeutic Drug D9943 — Occlusal Guard — By Report D9971 — Odontoplasty — 1–2 Teeth D9974 — Internal Bleaching — Per Tooth