Dental Reimbursement Rates in Missouri

D0372 — Cone Beam CT — 3D Data Capture (Both Jaws) D0415 — Collection of Microbial Culture Specimen D0417 — Collection of Saliva for Lab Analysis D0320 — TMJ Arthrogram D0310 — Sialography D0460 — Pulp Vitality Test D0145 — Oral Evaluation for Patient Under 3 D0210 — Full Mouth X-Rays D0277 — Vertical Bitewing X-Rays (7–8 Films) D0001 — Dental Procedure, By Report D0330 — Panoramic X-Ray D0486 — Accession of Transepithelial Cytologic Sample D0396 — 3D Volume Rendering of Image Data D0180 — Comprehensive Periodontal Evaluation D0322 — Tomographic Survey D0801 — 3D Surface Scan — Pre-Ortho D0802 — 3D Surface Scan — Post-Ortho D0220 — Periapical X-Ray — First Film D0321 — Other TMJ Films D0374 — Cone Beam CT — 3D Re-formatting D0470 — Diagnostic Cast D0150 — Comprehensive Oral Evaluation — New/Established D0170 — Re-evaluation — Limited, Problem Focused D0191 — Assessment of a Patient D0251 — Extraoral — Posterior Dental X-Ray D0270 — Bitewing X-Ray — Single Film D0274 — Bitewing X-Rays — Four Films D0120 — Periodic Oral Evaluation D0171 — Re-evaluation — Post-Operative D0240 — Occlusal X-Ray D0250 — Extraoral — 2D Projection D0373 — Cone Beam CT — 3D Interpretation (Both Jaws) D0418 — Analysis of Saliva Specimen D0426 — Caries Risk Assessment & Documentation (Low Risk) D0431 — Adjunctive Pre-Diagnostic Test (No Biopsy) D0461 — Pulp Vitality Test — Multiple Teeth D0601 — Caries Risk Assessment — Low Risk

D1526 — Space Maintainer — Removable, Bilateral (Maxillary) D1516 — Space Maintainer — Fixed, Bilateral (Maxillary) D1520 — Space Maintainer — Removable, Unilateral D1517 — Space Maintainer — Fixed, Bilateral (Mandibular) D1355 — Caries Preventive Medicament Application D1527 — Space Maintainer — Removable, Bilateral (Mandibular) D1510 — Space Maintainer — Fixed, Unilateral D1575 — Distal Shoe Space Maintainer D1351 — Dental Sealant — Per Tooth D1330 — Oral Hygiene Instructions D1120 — Child Prophylaxis D1552 — Re-cement/Re-bond Space Maintainer (Bilateral, Max) D1557 — Removal of Fixed Space Maintainer (Bilateral, Max) D1110 — Adult Prophylaxis (Cleaning) D1354 — Interim Caries Arresting Medicament (SDF) D1551 — Re-cement/Re-bond Space Maintainer (Unilateral) D1553 — Re-cement/Re-bond Space Maintainer (Bilateral, Mand) D1558 — Removal of Fixed Space Maintainer (Bilateral, Mand)

D2799 — Provisional Crown D2390 — Composite Crown — Anterior, Primary D2620 — Inlay — Porcelain/Ceramic, 2 Surfaces D2792 — Crown — Full Cast Noble Metal D2934 — Prefabricated Esthetic Coated SS Crown — Primary D2643 — Onlay — Porcelain/Ceramic, 3 Surfaces D2752 — Crown — Porcelain Fused to Noble Metal D2931 — Prefabricated Stainless Steel Crown — Permanent D2960 — Labial Veneer — Resin (Chair-side) D2721 — Crown — Resin with Base Metal D2722 — Crown — Resin with Noble Metal D2954 — Prefabricated Post and Core D2962 — Labial Veneer — Porcelain (Lab) D2664 — Onlay — Composite/Resin, 4+ Surfaces D2663 — Onlay — Composite/Resin, 3 Surfaces D2544 — Onlay — Metallic, 4+ Surfaces D2652 — Inlay — Composite/Resin, 3+ Surfaces D2510 — Inlay — Metallic, 1 Surface D2630 — Inlay — Porcelain/Ceramic, 3+ Surfaces D2662 — Onlay — Composite/Resin, 2 Surfaces D2740 — Crown — Porcelain/Ceramic D2160 — Amalgam Filling — 3 Surfaces, Primary/Permanent D2780 — Crown — ¾ Cast High Noble Metal D2982 — Onlay Repair, By Report D2542 — Onlay — Metallic, 2 Surfaces D2651 — Inlay — Composite/Resin, 2 Surfaces D2430 — Gold Foil — 3 Surfaces D2610 — Inlay — Porcelain/Ceramic, 1 Surface D2782 — Crown — ¾ Cast Noble Metal D2791 — Crown — Full Cast Base Metal D2921 — Reattachment of Tooth Fragment D2933 — Prefabricated SS Crown with Resin Window D2420 — Gold Foil — 2 Surfaces D2642 — Onlay — Porcelain/Ceramic, 2 Surfaces D2751 — Crown — Porcelain Fused to Base Metal D2783 — Crown — ¾ Porcelain/Ceramic D2981 — Inlay Repair, By Report D2330 — Composite Filling — 1 Surface, Anterior D2520 — Inlay — Metallic, 2 Surfaces D2543 — Onlay — Metallic, 3 Surfaces D2644 — Onlay — Porcelain/Ceramic, 4+ Surfaces D2790 — Crown — Full Cast High Noble Metal D2952 — Post and Core — Cast (w/ Crown) D2335 — Composite Filling — 4+ Surfaces/Incisal Angle D2394 — Composite Filling — 4+ Surfaces, Posterior D2781 — Crown — ¾ Cast Base Metal D2932 — Prefabricated Resin Crown D2955 — Post Removal D2331 — Composite Filling — 2 Surfaces, Anterior D2750 — Crown — Porcelain Fused to High Noble Metal D2140 — Amalgam Filling — 1 Surface, Primary/Permanent D2410 — Gold Foil — 1 Surface D2712 — Crown — ¾ Resin (Indirect) D2753 — Crown — Porcelain Fused to Titanium D2910 — Re-cement/Re-bond Inlay, Onlay, Veneer, or Partial D2393 — Composite Filling — 3 Surfaces, Posterior D2530 — Inlay — Metallic, 3+ Surfaces D2650 — Inlay — Composite/Resin, 1 Surface D2720 — Crown — Resin with High Noble Metal D2950 — Core Buildup Including Pins D2961 — Labial Veneer — Resin (Lab) D2980 — Crown Repair, By Report D2391 — Composite Filling — 1 Surface, Posterior D2940 — Protective Restoration (Sedative Filling) D2956 — Prefabricated Post and Core — Additional D2150 — Amalgam Filling — 2 Surfaces, Primary/Permanent D2953 — Post and Core — Each Additional (Cast) D2161 — Amalgam Filling — 4+ Surfaces, Primary/Permanent D2392 — Composite Filling — 2 Surfaces, Posterior D2929 — Prefabricated Porcelain/Ceramic Crown — Permanent D2332 — Composite Filling — 3 Surfaces, Anterior D2928 — Prefabricated Porcelain/Ceramic Crown — Primary D2983 — Veneer Repair, By Report D2990 — Resin Infiltration of Incipient Lesion D2710 — Crown — Resin (Indirect) D2930 — Prefabricated Stainless Steel Crown — Primary D2915 — Re-cement/Re-bond Cast or Prefab Post & Core D2920 — Re-cement/Re-bond Crown D2957 — Each Additional Prefabricated Post D2971 — Additional Procedures for Crown (Specify) D2976 — Stump Buildup with Pins

D3472 — Surgical Repair — Root Resorption (Premolar) D3432 — Guided Tissue Regeneration (Periradicular Surgery) D3426 — Apicoectomy — Each Additional Root D3320 — Root Canal — Premolar (Excluding Final Restoration) D3450 — Root Amputation — Per Root D3331 — Treatment of Root Canal Obstruction (Non-Surgical) D3421 — Apicoectomy — Premolar (First Root) D3310 — Root Canal — Anterior (Excluding Final Restoration) D3473 — Surgical Repair — Root Resorption (Molar) D3410 — Apicoectomy — Anterior D3471 — Surgical Repair — Root Resorption (Anterior) D3348 — Retreatment — Molar D3429 — Hemisection (Including Root Removal, Not Crown) D3470 — Intentional Reimplantation D3330 — Root Canal — Molar (Excluding Final Restoration) D3357 — Pulpal Regeneration — Final Visit D3425 — Apicoectomy — Molar (First Root) D3356 — Pulpal Regeneration — Interim Medication D3430 — Retrograde Filling — Per Root D3431 — Biologically-Based Root Treatment D3428 — Retrograde Filling — Per Root D3502 — Surgical Perforation Repair D3346 — Retreatment — Anterior D3351 — Apexification/Recalcification — Initial Visit D3347 — Retreatment — Premolar D3355 — Pulpal Regeneration — Initial Visit D3353 — Apexification/Recalcification — Final Visit D3920 — Hemisection (Not Root Canal/Restoration) D3921 — Decoronation/Intentional Submergence D3332 — Incomplete Endodontic Treatment (Inoperable/Fracture) D3240 — Pulpal Therapy — Posterior, Primary D3220 — Therapeutic Pulpotomy (Excluding Final Restoration) D3352 — Apexification/Recalcification — Interim Medication D3950 — Canal Prep and Fitting of Preformed Post/Dowel D3501 — Surgical Exposure for Canal Access D3503 — Surgical Root Repair — Anterior D3221 — Pulpal Debridement — Primary/Permanent Teeth D3110 — Pulp Cap — Direct (Excluding Final Restoration) D3222 — Partial Pulpotomy for Apexogenesis — Permanent D3333 — Internal Root Repair — Perforation D3120 — Pulp Cap — Indirect (Excluding Final Restoration) D3230 — Pulpal Therapy — Anterior, Primary D3910 — Surgical Procedure for Isolation of Tooth

D4210 — Gingivectomy/Gingivoplasty — 4+ Teeth (Per Quad) D4277 — Free Soft Tissue Graft (First Tooth) D4240 — Gingival Flap Surgery — 4+ Teeth (Per Quad) D4241 — Gingival Flap Surgery — 1–3 Teeth (Per Quad) D4260 — Osseous Surgery — 4+ Teeth (Per Quad) D4231 — Anatomical Crown Exposure — 1–3 Teeth (Per Quad) D4286 — Combined Connective Tissue Graft (Each Add'l Tooth) D4245 — Apically Positioned Flap D4261 — Osseous Surgery — 1–3 Teeth (Per Quad) D4265 — Biologic Material for Tissue Regeneration D4274 — Distal/Proximal Wedge Procedure D4263 — Bone Replacement Graft — First Site (Per Quad) D4266 — Guided Tissue Regeneration — Resorbable Barrier D4275 — Non-Autogenous Connective Tissue Graft (First Tooth) D4230 — Anatomical Crown Exposure — 4+ Teeth (Per Quad) D4322 — Splint — Intracoronal (Natural Teeth) D4267 — Guided Tissue Regeneration — Non-Resorbable Barrier D4276 — Combined Connective Tissue & Pedicle Graft D4270 — Pedicle Soft Tissue Graft D4278 — Free Soft Tissue Graft (Each Additional Tooth) D4273 — Autogenous Connective Tissue Graft (First Tooth) D4211 — Gingivectomy/Gingivoplasty — 1–3 Teeth (Per Quad) D4249 — Clinical Crown Lengthening — Hard Tissue D4264 — Bone Replacement Graft — Each Additional Site D4285 — Non-Autogenous Connective Tissue Graft (Each Add'l) D4920 — Unscheduled Dressing Change D4212 — Gingivectomy/Gingivoplasty (Restorative, Per Tooth) D4283 — Autogenous Connective Tissue Graft (Each Add'l Tooth) D4342 — Scaling and Root Planing — 1–3 Teeth (Per Quad) D4323 — Splint — Extracoronal (Natural Teeth) D4341 — Scaling and Root Planing — 4+ Teeth (Per Quad) D4355 — Full Mouth Debridement D4346 — Scaling — Generalized Moderate/Severe Gingivitis D4921 — Gingival Irrigation — Per Quadrant

D5810 — Interim Complete Upper Denture D5225 — Upper Partial Denture — Flexible Base D5223 — Immediate Upper Partial Denture — Cast Metal D5226 — Lower Partial Denture — Flexible Base D5283 — Removable Unilateral Partial Denture — 1 Piece (Resin) D5228 — Immediate Lower Partial Denture — Flexible Base D5130 — Immediate Upper Denture D5222 — Immediate Lower Partial Denture — Resin Base D5865 — Overdenture — Complete (Implant Supported) D5213 — Upper Partial Denture — Cast Metal Framework D5725 — Rebase Hybrid Prosthesis D5866 — Overdenture — Partial (Implant Supported) D5864 — Overdenture — Partial (Implant/Root Supported) D5761 — Reline Lower Partial Denture (Lab) D5140 — Immediate Lower Denture D5227 — Immediate Upper Partial Denture — Flexible Base D5811 — Interim Complete Lower Denture D5820 — Interim Partial Upper Denture D5110 — Complete Upper Denture D5120 — Complete Lower Denture D5221 — Immediate Upper Partial Denture — Resin Base D5765 — Soft Liner for Complete or Partial Denture D5877 — Replacement of Locator Male, By Report D5286 — Removable Unilateral Partial Denture — 2 Piece (Metal) D5211 — Upper Partial Denture — Resin Base (w/ Clasps/Rests) D5867 — Replacement of Attachment — Implant Overdenture D5991 — Vesiculobullous Disease Medicament Carrier D5214 — Lower Partial Denture — Cast Metal Framework D5224 — Immediate Lower Partial Denture — Cast Metal D5511 — Repair Broken Complete Denture Base (Upper) D5710 — Rebase Complete Upper Denture D5212 — Lower Partial Denture — Resin Base (w/ Clasps/Rests) D5282 — Removable Unilateral Partial Denture — 1 Piece (Metal) D5711 — Rebase Complete Lower Denture D5721 — Rebase Lower Partial Denture D5630 — Repair or Replace Broken Clasp — Per Tooth D5862 — Precision Attachment — By Report D5878 — Add Wrought Wire Clasp (Tooth-Supported) D5284 — Removable Unilateral Partial Denture — 1 Piece (Flex) D5760 — Reline Upper Partial Denture (Lab) D5720 — Rebase Upper Partial Denture D5821 — Interim Partial Lower Denture D5863 — Overdenture — Complete (Implant/Root Supported) D5640 — Replace Broken Teeth — Per Tooth D5751 — Reline Complete Lower Denture (Lab) D5621 — Repair Cast Partial Framework (Upper) D5622 — Repair Cast Partial Framework (Lower) D5670 — Replace Teeth & Acrylic on Metal Framework D5422 — Adjust Partial Lower Denture D5520 — Replace Missing/Broken Teeth — Complete Denture D5671 — Replace All Teeth & Acrylic on Cast Metal Framework D5731 — Reline Complete Lower Denture (Chair-side) D5660 — Add Clasp to Existing Partial Denture D5730 — Reline Complete Upper Denture (Chair-side) D5750 — Reline Complete Upper Denture (Lab) D5512 — Repair Broken Complete Denture Base (Lower) D5612 — Repair Resin Partial Denture Base (Lower) D5650 — Add Tooth to Existing Partial Denture D5611 — Repair Resin Partial Denture Base (Upper) D5850 — Tissue Conditioning (Upper) D5740 — Reline Upper Partial Denture (Chair-side) D5741 — Reline Lower Partial Denture (Chair-side) D5410 — Adjust Complete Upper Denture D5851 — Tissue Conditioning (Lower) D5875 — Modification of Removable Prosthesis (Implant) D5986 — Fluoride Gel Carrier D5992 — Adjust Maxillofacial Prosthetic Appliance D5993 — Maintenance/Cleaning of Maxillofacial Prosthesis

D6245 — Bridge Pontic — Porcelain/Ceramic D6121 — Implant-Supported Retainer — FPD (Noble) D6251 — Bridge Pontic — Resin with Base Metal D6784 — Bridge Retainer — ¾ Titanium D6106 — Bone Graft — Mandibular Symphysis D6608 — Bridge Retainer — Onlay, Porcelain/Ceramic (2 Surf) D6606 — Bridge Retainer — Inlay, Cast Noble Metal (2 Surf) D6721 — Bridge Retainer — Resin with Base Metal D6074 — Implant Bridge Pontic — Porcelain/Ceramic D6120 — Implant-Supported Retainer — FPD (High Noble) D6609 — Bridge Retainer — Onlay, Porcelain/Ceramic (3+ Surf) D6072 — Implant Bridge Pontic — Porcelain Fused to Metal D6195 — Implant-Supported Connector Bar (Modification) D6545 — Retainer — Cast Metal for Resin-Bonded Bridge D6751 — Bridge Retainer — Porcelain Fused to Base Metal D6792 — Bridge Retainer — Full Cast Noble Metal D6614 — Bridge Retainer — Onlay, Cast Noble Metal (2 Surf) D6710 — Bridge Retainer — Indirect Resin D6077 — Implant Crown — Noble Metal D6086 — Implant Crown — Resin D6252 — Bridge Pontic — Resin with Noble Metal D6782 — Bridge Retainer — ¾ Cast Noble Metal D6980 — Fixed Partial Denture Repair, By Report D6058 — Implant Abutment — Prefabricated D6103 — Bone Graft — Implant Repair (First Site) D6112 — Implant Bridge Retainer — Porcelain/Ceramic D6752 — Bridge Retainer — Porcelain Fused to Noble Metal D6063 — Implant Abutment — Cast-to (Base Metal) D6066 — Implant Crown — Porcelain Fused to Metal D6068 — Implant Abutment — Prefabricated D6088 — Implant Bridge Retainer — Resin D6192 — Semi-Precision Abutment — Removal D6123 — Implant-Supported Retainer — FPD (Titanium) D6243 — Bridge Pontic — Porcelain Fused to Titanium D6084 — Custom Implant Abutment (Porcelain/Ceramic) D6059 — Implant Abutment — Custom, By Report D6076 — Implant Crown — Base Metal D6101 — Debridement of Peri-Implant Defect — Surgical D6071 — Implant Crown — Cast Base Metal D6075 — Implant Crown — Porcelain Fused to Titanium D6241 — Bridge Pontic — Porcelain Fused to Base Metal D6600 — Bridge Retainer — Inlay, Porcelain/Ceramic (2 Surf) D6750 — Bridge Retainer — Porcelain Fused to High Noble Metal D6097 — Abutment-Supported Retainer (Removable) D6062 — Implant Abutment — Cast-to (Noble Metal) D6067 — Implant Crown — High Noble Metal D6069 — Implant Crown — Titanium D6111 — Implant Bridge Retainer — Porcelain Fused to BM D6013 — Surgical Placement — Mini Implant D6040 — Surgical Placement — Eposteal Implant D6083 — Implant-Supported Prosthesis Repair, By Report D6122 — Implant-Supported Retainer — FPD (Base) D6212 — Bridge Pontic — Cast Noble Metal D6099 — Implant-Supported Retainer for FPD (Ceramic) D6102 — Bone Graft — Debridement of Peri-Implant Defect D6110 — Implant Bridge Retainer — Porcelain Fused to HNM D6050 — Custom Fabricated Implant Abutment D6060 — Implant Abutment — Prefabricated (Noble Metal) D6780 — Bridge Retainer — ¾ Cast High Noble Metal D6793 — Bridge Retainer — Full Cast Titanium D6070 — Implant Crown — Cast High Noble Metal D6107 — Bone Graft — From Extra-Oral Donor Site D6113 — Implant Bridge Retainer — Cast Metal (HNM) D6242 — Bridge Pontic — Porcelain Fused to Noble Metal D6613 — Bridge Retainer — Onlay, Cast Base Metal (3+ Surf) D6720 — Bridge Retainer — Resin with High Noble Metal D6781 — Bridge Retainer — ¾ Cast Base Metal D6783 — Bridge Retainer — ¾ Porcelain/Ceramic D6211 — Bridge Pontic — Cast Base Metal D6055 — Dental Implant-Supported Connecting Bar D6061 — Implant Abutment — Prefabricated (Base Metal) D6087 — Implant Bridge Pontic — Resin D6104 — Bone Graft — Implant Repair (Each Add'l Site) D6240 — Bridge Pontic — Porcelain Fused to High Noble Metal D6253 — Provisional Bridge Pontic D6011 — Second Stage Implant Surgery D6051 — Interim Implant Abutment D6082 — Implant-Supported Crown Repair, By Report D6098 — Implant-Supported Retainer (Removable) D6603 — Bridge Retainer — Inlay, Cast High Noble Metal (3+ Surf) D6610 — Bridge Retainer — Onlay, Cast High Noble Metal (2 Surf) D6073 — Implant Bridge Pontic — Cast High Noble Metal D6210 — Bridge Pontic — Cast High Noble Metal D6602 — Bridge Retainer — Inlay, Cast High Noble Metal (2 Surf) D6064 — Implant Abutment — Prefabricated (Titanium) D6548 — Retainer — Porcelain/Ceramic for Resin-Bonded Bridge D6611 — Bridge Retainer — Onlay, Cast High Noble Metal (3+ Surf) D6612 — Bridge Retainer — Onlay, Cast Base Metal (2 Surf) D6950 — Precision Attachment D6010 — Surgical Placement — Endosteal Implant Body D6250 — Bridge Pontic — Resin with High Noble Metal D6065 — Implant Crown — Porcelain/Ceramic D6191 — Semi-Precision Abutment — Placement D6549 — Retainer — Resin for Resin-Bonded Bridge D6722 — Bridge Retainer — Resin with Noble Metal D6740 — Bridge Retainer — Porcelain/Ceramic D6753 — Bridge Retainer — Porcelain Fused to Titanium D6790 — Bridge Retainer — Full Cast High Noble Metal D6791 — Bridge Retainer — Full Cast Base Metal D6940 — Bridge Repair, By Report D6601 — Bridge Retainer — Inlay, Porcelain/Ceramic (3+ Surf) D6607 — Bridge Retainer — Inlay, Cast Noble Metal (3+ Surf) D6085 — Provisional Implant Crown D6089 — Implant Abutment Modification D6190 — Radiographic/Surgical Implant Index (Per Arch) D6091 — Implant Repair — Abutment Replacement D6057 — Custom Fabricated Implant Abutment D6096 — Remove Broken Implant Retaining Screw D6605 — Bridge Retainer — Inlay, Cast Base Metal (3+ Surf) D6056 — Prefabricated Implant Abutment D6615 — Bridge Retainer — Onlay, Cast Noble Metal (3+ Surf) D6280 — Bridge Pontic — Resin/Acrylic Denture Tooth D6604 — Bridge Retainer — Inlay, Cast Base Metal (2 Surf) D6920 — Connector Bar D6012 — Surgical Placement — Interim Implant Body D6180 — Implant-Supported Partial Denture (Upper) D6193 — Stress-Breaking Abutment — Placement D6198 — Remove Interim Implant Body D6080 — Implant Maintenance — Cleaning/Inspection D6930 — Re-cement/Re-bond Bridge D6092 — Re-cement/Re-bond Implant Crown D6093 — Re-cement/Re-bond Implant Bridge D6119 — Implant Bridge Retainer — Porcelain Fused to NM D6196 — Implant Provisional Crown (Implant Placement Visit) D6205 — Bridge Pontic — Indirect Composite/Resin

D7280 — Surgical Exposure of Impacted Tooth (Orthodontic) D7520 — Incision and Drainage — Extraoral (Soft Tissue) D7485 — Reduction of Osseous Tuberosity D7287 — Exfoliative Cytological Sample Collection D7880 — Occlusal Orthotic Device — By Report D7260 — Oroantral Fistula Closure D7473 — Removal of Torus Mandibularis D7961 — Buccal/Labial Frenectomy D7285 — Incisional Biopsy — Oral Tissue (Hard) D7340 — Vestibuloplasty — Ridge Extension D7451 — Removal of Benign Odontogenic Cyst > 1.25 cm D7472 — Removal of Torus Palatinus D7511 — Incision and Drainage — Intraoral (Soft Tissue, Complicated) D7972 — Surgical Reduction of Fibrous Tuberosity D7290 — Surgical Repositioning of Teeth D7320 — Alveoloplasty — Without Extractions (Per Quad) D7956 — Guided Bone Regeneration — Edentulous Area D7270 — Tooth Reimplantation/Stabilization D7286 — Incisional Biopsy — Oral Tissue (Soft) D7957 — Guided Bone Regeneration — Non-Resorbable Membrane D7970 — Excision of Hyperplastic Tissue — Per Arch D7297 — Corticotomy — Four or More Tooth Spaces D7310 — Alveoloplasty — With Extractions (Per Quad) D7350 — Vestibuloplasty — Ridge Extension (w/ Graft) D7950 — Osseous/Osteoperiosteal Graft — Mandible/Maxilla D7252 — Tooth Removal of Impacted Tooth (Soft Tissue) D7283 — Placement of Device for Eruption of Impacted Tooth D7284 — Excisional Biopsy — Bone D7994 — Surgical Placement — Bone-Fixation Plate D7220 — Extraction — Soft Tissue Impacted Tooth D7230 — Extraction — Partially Bony Impacted Tooth D7241 — Extraction — Completely Bony Impacted (Complicated) D7921 — Collection/Application of Autologous Blood Concentrate D7953 — Bone Replacement Graft — Ridge Preservation D7962 — Lingual Frenectomy D7510 — Incision and Drainage — Intraoral (Soft Tissue) D7955 — Repair of Maxillofacial Soft/Hard Tissue Defect D7321 — Alveoloplasty — Without Extractions (1–3 Teeth) D7272 — Tooth Transplantation D7282 — Mobilization of Erupted/Malpositioned Tooth D7450 — Removal of Benign Odontogenic Cyst ≤ 1.25 cm D7471 — Removal of Lateral Exostosis D7509 — Marsupialization of Cyst D7261 — Primary Closure of Sinus Perforation D7296 — Corticotomy — One to Three Tooth Spaces D7210 — Extraction — Surgical (Erupted Tooth) D7250 — Extraction — Residual Root Removal D7288 — Brush Biopsy — Transepithelial Sample Collection D7311 — Alveoloplasty — With Extractions (1–3 Teeth) D7410 — Excision of Benign Lesion ≤ 1.25 cm D7997 — Appliance Removal D7550 — Partial Ostectomy/Sequestrectomy D7240 — Extraction — Completely Bony Impacted Tooth D7251 — Coronectomy — Intentional Partial Tooth Removal D7922 — Placement of Intra-Socket Biological Dressing D7971 — Excision of Pericoronal Gingiva D7140 — Extraction — Erupted Tooth or Exposed Root D7939 — Unspecified Surgical Procedure, By Report D7291 — Transseptal Fiberotomy D7411 — Excision of Benign Lesion > 1.25 cm D7461 — Removal of Benign Non-Odontogenic Cyst > 1.25 cm D7530 — Removal of Foreign Body — Skin/Areolar Tissue D7540 — Removal of Reaction-Producing Foreign Body (Musculoskeletal) D7870 — Arthrocentesis D7881 — Occlusal Orthotic Device — Adjustment D7940 — Osteoplasty — Jaw Recontouring D7963 — Frenuloplasty

D8090 — Comprehensive Orthodontic — Adult Dentition D8696 — Repair of Orthodontic Appliance D8220 — Fixed Appliance Therapy D8660 — Pre-Orthodontic Treatment Exam D8091 — Comprehensive Orthodontic — By Report D8070 — Comprehensive Orthodontic — Transitional Dentition D8080 — Comprehensive Orthodontic — Adolescent Dentition D8699 — Re-cement/Re-bond Fixed Retainer, By Report D8680 — Orthodontic Retention — Removable Appliance D8681 — Orthodontic Retention — Fixed Appliance D8697 — Re-cement/Re-bond Fixed Retainer (Maxillary) D8210 — Removable Appliance Therapy D8670 — Periodic Orthodontic Treatment Visit D8671 — Periodic Orthodontic Treatment Visit (As Part of Contract) D8701 — Repair of Fixed Retainer (Includes Re-attachment)

D9612 — Therapeutic Parenteral Drug — Two+ Administrations D9952 — Occlusal Adjustment — Complete D9224 — Deep Sedation/General Anesthesia — First 15 min (Dentist) D9110 — Palliative (Emergency) Treatment D9944 — Occlusal Guard — Hard Appliance (Full Arch) D9430 — Office Visit for Observation (No Services) D9970 — Enamel Microabrasion D9239 — Intravenous Moderate Sedation — First 15 min D9420 — Hospital or ASC Call D9950 — Occlusion Analysis — Mounted Case D9974 — Internal Bleaching — Per Tooth D9225 — Deep Sedation/General Anesthesia — Each Add'l 15 min (Dentist) D9911 — Application of Desensitizing Resin D9912 — Pre-Visit Patient Screening D9946 — Occlusal Guard — Hard Appliance (Partial Arch) D9219 — Evaluation for Moderate Sedation D9222 — Deep Sedation/General Anesthesia — First 15 min D9223 — Deep Sedation/General Anesthesia — Each Add'l 15 min D9245 — Non-IV Moderate Conscious Sedation — First 15 min D9310 — Consultation — Specialist/Dentist D9971 — Odontoplasty — 1–2 Teeth D9941 — Fabrication of Athletic Mouthguard D9945 — Occlusal Guard — Soft Appliance (Full Arch) D9951 — Occlusal Adjustment — Limited D9230 — Inhalation Analgesia (Nitrous Oxide) D9246 — Non-IV Moderate Conscious Sedation — Each Add'l 15 min D9440 — Office Visit — After Regular Hours D9613 — Infiltration of Sustained-Release Therapeutic Drug D9975 — External Bleaching (Home Application, Per Arch) D9247 — Non-IV Moderate Conscious Sedation — Supplemental D9410 — House/Extended Care Facility Call D9610 — Therapeutic Parenteral Drug — Single Admin D9630 — Drugs or Medicaments (Not Otherwise Classified) D9128 — Metal-Based Temporization/Splinting (Single Tooth) D9129 — Metal-Based Temporization/Splinting (Each Additional) D9243 — Intravenous Moderate Sedation — Each Add'l 15 min D9943 — Occlusal Guard — By Report D9120 — Fixed Partial Denture Sectioning D9210 — Local Anesthesia (Not w/ Procedure) D9212 — Trigeminal Division Block Anesthesia D9215 — Local Anesthesia (In Conjunction w/ Procedure) D9244 — Non-IV Moderate Conscious Sedation (By Non-Treating Dentist) D9920 — Behavior Management — By Report D9938 — Adjustment of Appliance (Obstructive Sleep Apnea) D9972 — External Bleaching — Per Arch