Dental Reimbursement Rates in Puerto Rico

Negotiated dental rates across 138 CDT procedure codes in Puerto Rico, sourced from CMS Transparency in Coverage data. 162 rate records.

CDT Codes

138

Providers

21

Rate Records

162

Top Procedures in Puerto Rico

Code	Procedure	Average	Median	Min	Max	Records
D5225	Upper Partial Denture — Flexible Base	$888	$926	$812	$926	3
D6061	Implant Abutment — Prefabricated (Base Metal)	$924	$791	$749	$1,231	3
D7287	Exfoliative Cytological Sample Collection	$146	$179	$81	$179	3
D1120	Child Prophylaxis	$44	$44	$44	$44	2
D1206	Fluoride Varnish Treatment	$20	$20	$20	$20	2
D1527	Space Maintainer — Removable, Bilateral (Mandibular)	$391	$391	$339	$443	2
D2750	Crown — Porcelain Fused to High Noble Metal	$675	$675	$661	$689	2
D2960	Labial Veneer — Resin (Chair-side)	$388	$388	$294	$481	2
D3432	Guided Tissue Regeneration (Periradicular Surgery)	$305	$305	$305	$305	2
D4276	Combined Connective Tissue & Pedicle Graft	$318	$318	$238	$397	2
D5223	Immediate Upper Partial Denture — Cast Metal	$849	$849	$831	$867	2
D5877	Replacement of Locator Male, By Report	$354	$354	$295	$414	2
D6058	Implant Abutment — Prefabricated	$1,076	$1,076	$817	$1,336	2
D6072	Implant Bridge Pontic — Porcelain Fused to Metal	$775	$775	$775	$775	2
D6611	Bridge Retainer — Onlay, Cast High Noble Metal (3+ Surf)	$679	$679	$679	$679	2
D6720	Bridge Retainer — Resin with High Noble Metal	$667	$667	$667	$667	2
D6783	Bridge Retainer — ¾ Porcelain/Ceramic	$673	$673	$673	$673	2
D7270	Tooth Reimplantation/Stabilization	$376	$376	$327	$426	2
D7350	Vestibuloplasty — Ridge Extension (w/ Graft)	$2,886	$2,886	$2,153	$3,619	2
D7520	Incision and Drainage — Extraoral (Soft Tissue)	$550	$550	$550	$550	2

All 138 CDT Codes in Puerto Rico

Diagnostic (3)

D0171 — Re-evaluation — Post-Operative D0251 — Extraoral — Posterior Dental X-Ray D0340 — 2D Cephalometric X-Ray

Preventive (4)

D1120 — Child Prophylaxis D1206 — Fluoride Varnish Treatment D1527 — Space Maintainer — Removable, Bilateral (Mandibular) D1310 — Nutritional Counseling for Dental Caries

Restorative (18)

D2750 — Crown — Porcelain Fused to High Noble Metal D2960 — Labial Veneer — Resin (Chair-side) D2150 — Amalgam Filling — 2 Surfaces, Primary/Permanent D2161 — Amalgam Filling — 4+ Surfaces, Primary/Permanent D2332 — Composite Filling — 3 Surfaces, Anterior D2394 — Composite Filling — 4+ Surfaces, Posterior D2430 — Gold Foil — 3 Surfaces D2530 — Inlay — Metallic, 3+ Surfaces D2544 — Onlay — Metallic, 4+ Surfaces D2630 — Inlay — Porcelain/Ceramic, 3+ Surfaces D2664 — Onlay — Composite/Resin, 4+ Surfaces D2710 — Crown — Resin (Indirect) D2722 — Crown — Resin with Noble Metal D2782 — Crown — ¾ Cast Noble Metal D2920 — Re-cement/Re-bond Crown D2953 — Post and Core — Each Additional (Cast) D2962 — Labial Veneer — Porcelain (Lab) D2982 — Onlay Repair, By Report

Endodontics (12)

D3432 — Guided Tissue Regeneration (Periradicular Surgery) D3220 — Therapeutic Pulpotomy (Excluding Final Restoration) D3240 — Pulpal Therapy — Posterior, Primary D3310 — Root Canal — Anterior (Excluding Final Restoration) D3346 — Retreatment — Anterior D3348 — Retreatment — Molar D3351 — Apexification/Recalcification — Initial Visit D3410 — Apicoectomy — Anterior D3421 — Apicoectomy — Premolar (First Root) D3426 — Apicoectomy — Each Additional Root D3430 — Retrograde Filling — Per Root D3502 — Surgical Perforation Repair

Periodontics (11)

D4276 — Combined Connective Tissue & Pedicle Graft D4210 — Gingivectomy/Gingivoplasty — 4+ Teeth (Per Quad) D4212 — Gingivectomy/Gingivoplasty (Restorative, Per Tooth) D4231 — Anatomical Crown Exposure — 1–3 Teeth (Per Quad) D4245 — Apically Positioned Flap D4249 — Clinical Crown Lengthening — Hard Tissue D4260 — Osseous Surgery — 4+ Teeth (Per Quad) D4266 — Guided Tissue Regeneration — Resorbable Barrier D4274 — Distal/Proximal Wedge Procedure D4278 — Free Soft Tissue Graft (Each Additional Tooth) D4323 — Splint — Extracoronal (Natural Teeth)

Prosthodontics (19)

D5225 — Upper Partial Denture — Flexible Base D5223 — Immediate Upper Partial Denture — Cast Metal D5877 — Replacement of Locator Male, By Report D5120 — Complete Lower Denture D5130 — Immediate Upper Denture D5140 — Immediate Lower Denture D5212 — Lower Partial Denture — Resin Base (w/ Clasps/Rests) D5224 — Immediate Lower Partial Denture — Cast Metal D5226 — Lower Partial Denture — Flexible Base D5227 — Immediate Upper Partial Denture — Flexible Base D5286 — Removable Unilateral Partial Denture — 2 Piece (Metal) D5612 — Repair Resin Partial Denture Base (Lower) D5710 — Rebase Complete Upper Denture D5720 — Rebase Upper Partial Denture D5741 — Reline Lower Partial Denture (Chair-side) D5760 — Reline Upper Partial Denture (Lab) D5761 — Reline Lower Partial Denture (Lab) D5863 — Overdenture — Complete (Implant/Root Supported) D5878 — Add Wrought Wire Clasp (Tooth-Supported)

Implants & Fixed Prosth. (34)

D6061 — Implant Abutment — Prefabricated (Base Metal) D6058 — Implant Abutment — Prefabricated D6072 — Implant Bridge Pontic — Porcelain Fused to Metal D6611 — Bridge Retainer — Onlay, Cast High Noble Metal (3+ Surf) D6720 — Bridge Retainer — Resin with High Noble Metal D6783 — Bridge Retainer — ¾ Porcelain/Ceramic D6010 — Surgical Placement — Endosteal Implant Body D6055 — Dental Implant-Supported Connecting Bar D6060 — Implant Abutment — Prefabricated (Noble Metal) D6063 — Implant Abutment — Cast-to (Base Metal) D6064 — Implant Abutment — Prefabricated (Titanium) D6067 — Implant Crown — High Noble Metal D6075 — Implant Crown — Porcelain Fused to Titanium D6084 — Custom Implant Abutment (Porcelain/Ceramic) D6091 — Implant Repair — Abutment Replacement D6093 — Re-cement/Re-bond Implant Bridge D6097 — Abutment-Supported Retainer (Removable) D6103 — Bone Graft — Implant Repair (First Site) D6104 — Bone Graft — Implant Repair (Each Add'l Site) D6120 — Implant-Supported Retainer — FPD (High Noble) D6123 — Implant-Supported Retainer — FPD (Titanium) D6191 — Semi-Precision Abutment — Placement D6212 — Bridge Pontic — Cast Noble Metal D6240 — Bridge Pontic — Porcelain Fused to High Noble Metal D6250 — Bridge Pontic — Resin with High Noble Metal D6545 — Retainer — Cast Metal for Resin-Bonded Bridge D6600 — Bridge Retainer — Inlay, Porcelain/Ceramic (2 Surf) D6606 — Bridge Retainer — Inlay, Cast Noble Metal (2 Surf) D6607 — Bridge Retainer — Inlay, Cast Noble Metal (3+ Surf) D6609 — Bridge Retainer — Onlay, Porcelain/Ceramic (3+ Surf) D6614 — Bridge Retainer — Onlay, Cast Noble Metal (2 Surf) D6781 — Bridge Retainer — ¾ Cast Base Metal D6782 — Bridge Retainer — ¾ Cast Noble Metal D6792 — Bridge Retainer — Full Cast Noble Metal

Oral Surgery (22)

D7287 — Exfoliative Cytological Sample Collection D7270 — Tooth Reimplantation/Stabilization D7350 — Vestibuloplasty — Ridge Extension (w/ Graft) D7520 — Incision and Drainage — Extraoral (Soft Tissue) D7220 — Extraction — Soft Tissue Impacted Tooth D7272 — Tooth Transplantation D7284 — Excisional Biopsy — Bone D7288 — Brush Biopsy — Transepithelial Sample Collection D7290 — Surgical Repositioning of Teeth D7320 — Alveoloplasty — Without Extractions (Per Quad) D7340 — Vestibuloplasty — Ridge Extension D7411 — Excision of Benign Lesion > 1.25 cm D7450 — Removal of Benign Odontogenic Cyst ≤ 1.25 cm D7471 — Removal of Lateral Exostosis D7509 — Marsupialization of Cyst D7560 — Maxillary Sinusotomy for Removal of Tooth Fragment D7880 — Occlusal Orthotic Device — By Report D7950 — Osseous/Osteoperiosteal Graft — Mandible/Maxilla D7953 — Bone Replacement Graft — Ridge Preservation D7956 — Guided Bone Regeneration — Edentulous Area D7963 — Frenuloplasty D7970 — Excision of Hyperplastic Tissue — Per Arch

Orthodontics (3)

D8220 — Fixed Appliance Therapy D8660 — Pre-Orthodontic Treatment Exam D8671 — Periodic Orthodontic Treatment Visit (As Part of Contract)

General Services (12)

D9129 — Metal-Based Temporization/Splinting (Each Additional) D9210 — Local Anesthesia (Not w/ Procedure) D9225 — Deep Sedation/General Anesthesia — Each Add'l 15 min (Dentist) D9230 — Inhalation Analgesia (Nitrous Oxide) D9247 — Non-IV Moderate Conscious Sedation — Supplemental D9311 — Consultation — With Another Dentist/Physician D9410 — House/Extended Care Facility Call D9612 — Therapeutic Parenteral Drug — Two+ Administrations D9910 — Application of Desensitizing Medicament D9944 — Occlusal Guard — Hard Appliance (Full Arch) D9970 — Enamel Microabrasion D9972 — External Bleaching — Per Arch

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