Dental Reimbursement Rates in Virginia

D0320 — TMJ Arthrogram D0180 — Comprehensive Periodontal Evaluation D0251 — Extraoral — Posterior Dental X-Ray D0374 — Cone Beam CT — 3D Re-formatting D0310 — Sialography D0250 — Extraoral — 2D Projection D0322 — Tomographic Survey D0470 — Diagnostic Cast D0486 — Accession of Transepithelial Cytologic Sample D0145 — Oral Evaluation for Patient Under 3 D0273 — Bitewing X-Rays — Three Films D0330 — Panoramic X-Ray D0340 — 2D Cephalometric X-Ray D0350 — Oral/Facial Photographic Images D0372 — Cone Beam CT — 3D Data Capture (Both Jaws) D0160 — Detailed/Extensive Oral Evaluation D0277 — Vertical Bitewing X-Rays (7–8 Films) D0396 — 3D Volume Rendering of Image Data D0801 — 3D Surface Scan — Pre-Ortho D0140 — Limited Oral Evaluation — Problem Focused D0150 — Comprehensive Oral Evaluation — New/Established D0170 — Re-evaluation — Limited, Problem Focused D0171 — Re-evaluation — Post-Operative D0270 — Bitewing X-Ray — Single Film D0393 — Treatment Simulation (3D) D0461 — Pulp Vitality Test — Multiple Teeth D0120 — Periodic Oral Evaluation D0191 — Assessment of a Patient D0230 — Periapical X-Ray — Each Additional Film D0240 — Occlusal X-Ray D0274 — Bitewing X-Rays — Four Films D0417 — Collection of Saliva for Lab Analysis D0601 — Caries Risk Assessment — Low Risk D0602 — Caries Risk Assessment — Moderate Risk D0603 — Caries Risk Assessment — High Risk D0802 — 3D Surface Scan — Post-Ortho

D1526 — Space Maintainer — Removable, Bilateral (Maxillary) D1517 — Space Maintainer — Fixed, Bilateral (Mandibular) D1527 — Space Maintainer — Removable, Bilateral (Mandibular) D1510 — Space Maintainer — Fixed, Unilateral D1575 — Distal Shoe Space Maintainer D1354 — Interim Caries Arresting Medicament (SDF) D1520 — Space Maintainer — Removable, Unilateral D1208 — Fluoride Application (Excluding Varnish) D1206 — Fluoride Varnish Treatment D1516 — Space Maintainer — Fixed, Bilateral (Maxillary) D1557 — Removal of Fixed Space Maintainer (Bilateral, Max) D1110 — Adult Prophylaxis (Cleaning) D1553 — Re-cement/Re-bond Space Maintainer (Bilateral, Mand) D1301 — Panoramic Radiograph for Caries Risk D1355 — Caries Preventive Medicament Application D1558 — Removal of Fixed Space Maintainer (Bilateral, Mand) D1330 — Oral Hygiene Instructions D1353 — Sealant Repair — Per Tooth D1552 — Re-cement/Re-bond Space Maintainer (Bilateral, Max) D1556 — Removal of Fixed Space Maintainer (Unilateral)

D2643 — Onlay — Porcelain/Ceramic, 3 Surfaces D2932 — Prefabricated Resin Crown D2962 — Labial Veneer — Porcelain (Lab) D2933 — Prefabricated SS Crown with Resin Window D2954 — Prefabricated Post and Core D2961 — Labial Veneer — Resin (Lab) D2630 — Inlay — Porcelain/Ceramic, 3+ Surfaces D2753 — Crown — Porcelain Fused to Titanium D2950 — Core Buildup Including Pins D2520 — Inlay — Metallic, 2 Surfaces D2929 — Prefabricated Porcelain/Ceramic Crown — Permanent D2990 — Resin Infiltration of Incipient Lesion D2662 — Onlay — Composite/Resin, 2 Surfaces D2663 — Onlay — Composite/Resin, 3 Surfaces D2982 — Onlay Repair, By Report D2652 — Inlay — Composite/Resin, 3+ Surfaces D2792 — Crown — Full Cast Noble Metal D2957 — Each Additional Prefabricated Post D2510 — Inlay — Metallic, 1 Surface D2542 — Onlay — Metallic, 2 Surfaces D2642 — Onlay — Porcelain/Ceramic, 2 Surfaces D2710 — Crown — Resin (Indirect) D2740 — Crown — Porcelain/Ceramic D2782 — Crown — ¾ Cast Noble Metal D2953 — Post and Core — Each Additional (Cast) D2331 — Composite Filling — 2 Surfaces, Anterior D2644 — Onlay — Porcelain/Ceramic, 4+ Surfaces D2720 — Crown — Resin with High Noble Metal D2722 — Crown — Resin with Noble Metal D2750 — Crown — Porcelain Fused to High Noble Metal D2780 — Crown — ¾ Cast High Noble Metal D2543 — Onlay — Metallic, 3 Surfaces D2752 — Crown — Porcelain Fused to Noble Metal D2783 — Crown — ¾ Porcelain/Ceramic D2791 — Crown — Full Cast Base Metal D2420 — Gold Foil — 2 Surfaces D2430 — Gold Foil — 3 Surfaces D2610 — Inlay — Porcelain/Ceramic, 1 Surface D2664 — Onlay — Composite/Resin, 4+ Surfaces D2712 — Crown — ¾ Resin (Indirect) D2721 — Crown — Resin with Base Metal D2751 — Crown — Porcelain Fused to Base Metal D2921 — Reattachment of Tooth Fragment D2981 — Inlay Repair, By Report D2983 — Veneer Repair, By Report D2150 — Amalgam Filling — 2 Surfaces, Primary/Permanent D2161 — Amalgam Filling — 4+ Surfaces, Primary/Permanent D2392 — Composite Filling — 2 Surfaces, Posterior D2790 — Crown — Full Cast High Noble Metal D2799 — Provisional Crown D2928 — Prefabricated Porcelain/Ceramic Crown — Primary D2931 — Prefabricated Stainless Steel Crown — Permanent D2980 — Crown Repair, By Report D2410 — Gold Foil — 1 Surface D2530 — Inlay — Metallic, 3+ Surfaces D2544 — Onlay — Metallic, 4+ Surfaces D2651 — Inlay — Composite/Resin, 2 Surfaces D2781 — Crown — ¾ Cast Base Metal D2960 — Labial Veneer — Resin (Chair-side) D2390 — Composite Crown — Anterior, Primary D2620 — Inlay — Porcelain/Ceramic, 2 Surfaces D2335 — Composite Filling — 4+ Surfaces/Incisal Angle D2650 — Inlay — Composite/Resin, 1 Surface D2934 — Prefabricated Esthetic Coated SS Crown — Primary D2330 — Composite Filling — 1 Surface, Anterior D2332 — Composite Filling — 3 Surfaces, Anterior D2393 — Composite Filling — 3 Surfaces, Posterior D2394 — Composite Filling — 4+ Surfaces, Posterior D2952 — Post and Core — Cast (w/ Crown) D2140 — Amalgam Filling — 1 Surface, Primary/Permanent D2976 — Stump Buildup with Pins D2160 — Amalgam Filling — 3 Surfaces, Primary/Permanent D2391 — Composite Filling — 1 Surface, Posterior D2991 — Mineral Infiltration of Incipient Lesion D2915 — Re-cement/Re-bond Cast or Prefab Post & Core D2930 — Prefabricated Stainless Steel Crown — Primary D2940 — Protective Restoration (Sedative Filling) D2955 — Post Removal D2910 — Re-cement/Re-bond Inlay, Onlay, Veneer, or Partial D2920 — Re-cement/Re-bond Crown D2956 — Prefabricated Post and Core — Additional

D3421 — Apicoectomy — Premolar (First Root) D3347 — Retreatment — Premolar D3332 — Incomplete Endodontic Treatment (Inoperable/Fracture) D3330 — Root Canal — Molar (Excluding Final Restoration) D3333 — Internal Root Repair — Perforation D3450 — Root Amputation — Per Root D3501 — Surgical Exposure for Canal Access D3910 — Surgical Procedure for Isolation of Tooth D3432 — Guided Tissue Regeneration (Periradicular Surgery) D3221 — Pulpal Debridement — Primary/Permanent Teeth D3470 — Intentional Reimplantation D3472 — Surgical Repair — Root Resorption (Premolar) D3331 — Treatment of Root Canal Obstruction (Non-Surgical) D3431 — Biologically-Based Root Treatment D3503 — Surgical Root Repair — Anterior D3230 — Pulpal Therapy — Anterior, Primary D3310 — Root Canal — Anterior (Excluding Final Restoration) D3353 — Apexification/Recalcification — Final Visit D3426 — Apicoectomy — Each Additional Root D3430 — Retrograde Filling — Per Root D3921 — Decoronation/Intentional Submergence D3320 — Root Canal — Premolar (Excluding Final Restoration) D3348 — Retreatment — Molar D3425 — Apicoectomy — Molar (First Root) D3351 — Apexification/Recalcification — Initial Visit D3355 — Pulpal Regeneration — Initial Visit D3920 — Hemisection (Not Root Canal/Restoration) D3950 — Canal Prep and Fitting of Preformed Post/Dowel D3357 — Pulpal Regeneration — Final Visit D3429 — Hemisection (Including Root Removal, Not Crown) D3473 — Surgical Repair — Root Resorption (Molar) D3110 — Pulp Cap — Direct (Excluding Final Restoration) D3346 — Retreatment — Anterior D3410 — Apicoectomy — Anterior D3471 — Surgical Repair — Root Resorption (Anterior) D3502 — Surgical Perforation Repair D3240 — Pulpal Therapy — Posterior, Primary D3428 — Retrograde Filling — Per Root D3120 — Pulp Cap — Indirect (Excluding Final Restoration) D3220 — Therapeutic Pulpotomy (Excluding Final Restoration) D3911 — Endodontic Re-opening for Drainage D3352 — Apexification/Recalcification — Interim Medication D3356 — Pulpal Regeneration — Interim Medication

D4265 — Biologic Material for Tissue Regeneration D4273 — Autogenous Connective Tissue Graft (First Tooth) D4276 — Combined Connective Tissue & Pedicle Graft D4286 — Combined Connective Tissue Graft (Each Add'l Tooth) D4267 — Guided Tissue Regeneration — Non-Resorbable Barrier D4278 — Free Soft Tissue Graft (Each Additional Tooth) D4266 — Guided Tissue Regeneration — Resorbable Barrier D4231 — Anatomical Crown Exposure — 1–3 Teeth (Per Quad) D4241 — Gingival Flap Surgery — 1–3 Teeth (Per Quad) D4261 — Osseous Surgery — 1–3 Teeth (Per Quad) D4245 — Apically Positioned Flap D4240 — Gingival Flap Surgery — 4+ Teeth (Per Quad) D4210 — Gingivectomy/Gingivoplasty — 4+ Teeth (Per Quad) D4211 — Gingivectomy/Gingivoplasty — 1–3 Teeth (Per Quad) D4249 — Clinical Crown Lengthening — Hard Tissue D4283 — Autogenous Connective Tissue Graft (Each Add'l Tooth) D4212 — Gingivectomy/Gingivoplasty (Restorative, Per Tooth) D4275 — Non-Autogenous Connective Tissue Graft (First Tooth) D4341 — Scaling and Root Planing — 4+ Teeth (Per Quad) D4921 — Gingival Irrigation — Per Quadrant D4230 — Anatomical Crown Exposure — 4+ Teeth (Per Quad) D4274 — Distal/Proximal Wedge Procedure D4355 — Full Mouth Debridement D4270 — Pedicle Soft Tissue Graft D4322 — Splint — Intracoronal (Natural Teeth) D4260 — Osseous Surgery — 4+ Teeth (Per Quad) D4277 — Free Soft Tissue Graft (First Tooth) D4323 — Splint — Extracoronal (Natural Teeth) D4342 — Scaling and Root Planing — 1–3 Teeth (Per Quad) D4263 — Bone Replacement Graft — First Site (Per Quad) D4285 — Non-Autogenous Connective Tissue Graft (Each Add'l) D4264 — Bone Replacement Graft — Each Additional Site D4381 — Localized Antimicrobial Delivery (Per Tooth) D4268 — Surgical Revision (Failed Previous Graft Site) D4920 — Unscheduled Dressing Change D4346 — Scaling — Generalized Moderate/Severe Gingivitis D4910 — Periodontal Maintenance

D5750 — Reline Complete Upper Denture (Lab) D5120 — Complete Lower Denture D5863 — Overdenture — Complete (Implant/Root Supported) D5227 — Immediate Upper Partial Denture — Flexible Base D5225 — Upper Partial Denture — Flexible Base D5110 — Complete Upper Denture D5130 — Immediate Upper Denture D5224 — Immediate Lower Partial Denture — Cast Metal D5864 — Overdenture — Partial (Implant/Root Supported) D5140 — Immediate Lower Denture D5761 — Reline Lower Partial Denture (Lab) D5214 — Lower Partial Denture — Cast Metal Framework D5866 — Overdenture — Partial (Implant Supported) D5213 — Upper Partial Denture — Cast Metal Framework D5286 — Removable Unilateral Partial Denture — 2 Piece (Metal) D5710 — Rebase Complete Upper Denture D5223 — Immediate Upper Partial Denture — Cast Metal D5226 — Lower Partial Denture — Flexible Base D5282 — Removable Unilateral Partial Denture — 1 Piece (Metal) D5211 — Upper Partial Denture — Resin Base (w/ Clasps/Rests) D5212 — Lower Partial Denture — Resin Base (w/ Clasps/Rests) D5811 — Interim Complete Lower Denture D5867 — Replacement of Attachment — Implant Overdenture D5228 — Immediate Lower Partial Denture — Flexible Base D5284 — Removable Unilateral Partial Denture — 1 Piece (Flex) D5660 — Add Clasp to Existing Partial Denture D5721 — Rebase Lower Partial Denture D5751 — Reline Complete Lower Denture (Lab) D5850 — Tissue Conditioning (Upper) D5878 — Add Wrought Wire Clasp (Tooth-Supported) D5612 — Repair Resin Partial Denture Base (Lower) D5820 — Interim Partial Upper Denture D5671 — Replace All Teeth & Acrylic on Cast Metal Framework D5765 — Soft Liner for Complete or Partial Denture D5222 — Immediate Lower Partial Denture — Resin Base D5421 — Adjust Partial Upper Denture D5611 — Repair Resin Partial Denture Base (Upper) D5862 — Precision Attachment — By Report D5865 — Overdenture — Complete (Implant Supported) D5283 — Removable Unilateral Partial Denture — 1 Piece (Resin) D5512 — Repair Broken Complete Denture Base (Lower) D5650 — Add Tooth to Existing Partial Denture D5760 — Reline Upper Partial Denture (Lab) D5810 — Interim Complete Upper Denture D5670 — Replace Teeth & Acrylic on Metal Framework D5720 — Rebase Upper Partial Denture D5821 — Interim Partial Lower Denture D5877 — Replacement of Locator Male, By Report D5221 — Immediate Upper Partial Denture — Resin Base D5411 — Adjust Complete Lower Denture D5711 — Rebase Complete Lower Denture D5725 — Rebase Hybrid Prosthesis D5731 — Reline Complete Lower Denture (Chair-side) D5741 — Reline Lower Partial Denture (Chair-side) D5982 — Surgical Stent D5511 — Repair Broken Complete Denture Base (Upper) D5621 — Repair Cast Partial Framework (Upper) D5622 — Repair Cast Partial Framework (Lower) D5986 — Fluoride Gel Carrier D5520 — Replace Missing/Broken Teeth — Complete Denture D5730 — Reline Complete Upper Denture (Chair-side) D5740 — Reline Upper Partial Denture (Chair-side) D5851 — Tissue Conditioning (Lower) D5630 — Repair or Replace Broken Clasp — Per Tooth D5640 — Replace Broken Teeth — Per Tooth D5410 — Adjust Complete Upper Denture D5422 — Adjust Partial Lower Denture D5991 — Vesiculobullous Disease Medicament Carrier D5993 — Maintenance/Cleaning of Maxillofacial Prosthesis

D6061 — Implant Abutment — Prefabricated (Base Metal) D6721 — Bridge Retainer — Resin with Base Metal D6253 — Provisional Bridge Pontic D6600 — Bridge Retainer — Inlay, Porcelain/Ceramic (2 Surf) D6050 — Custom Fabricated Implant Abutment D6240 — Bridge Pontic — Porcelain Fused to High Noble Metal D6614 — Bridge Retainer — Onlay, Cast Noble Metal (2 Surf) D6920 — Connector Bar D6069 — Implant Crown — Titanium D6113 — Implant Bridge Retainer — Cast Metal (HNM) D6780 — Bridge Retainer — ¾ Cast High Noble Metal D6940 — Bridge Repair, By Report D6066 — Implant Crown — Porcelain Fused to Metal D6110 — Implant Bridge Retainer — Porcelain Fused to HNM D6191 — Semi-Precision Abutment — Placement D6075 — Implant Crown — Porcelain Fused to Titanium D6602 — Bridge Retainer — Inlay, Cast High Noble Metal (2 Surf) D6604 — Bridge Retainer — Inlay, Cast Base Metal (2 Surf) D6753 — Bridge Retainer — Porcelain Fused to Titanium D6241 — Bridge Pontic — Porcelain Fused to Base Metal D6606 — Bridge Retainer — Inlay, Cast Noble Metal (2 Surf) D6062 — Implant Abutment — Cast-to (Noble Metal) D6123 — Implant-Supported Retainer — FPD (Titanium) D6251 — Bridge Pontic — Resin with Base Metal D6611 — Bridge Retainer — Onlay, Cast High Noble Metal (3+ Surf) D6040 — Surgical Placement — Eposteal Implant D6074 — Implant Bridge Pontic — Porcelain/Ceramic D6098 — Implant-Supported Retainer (Removable) D6103 — Bone Graft — Implant Repair (First Site) D6609 — Bridge Retainer — Onlay, Porcelain/Ceramic (3+ Surf) D6612 — Bridge Retainer — Onlay, Cast Base Metal (2 Surf) D6010 — Surgical Placement — Endosteal Implant Body D6068 — Implant Abutment — Prefabricated D6070 — Implant Crown — Cast High Noble Metal D6120 — Implant-Supported Retainer — FPD (High Noble) D6252 — Bridge Pontic — Resin with Noble Metal D6781 — Bridge Retainer — ¾ Cast Base Metal D6057 — Custom Fabricated Implant Abutment D6250 — Bridge Pontic — Resin with High Noble Metal D6782 — Bridge Retainer — ¾ Cast Noble Metal D6063 — Implant Abutment — Cast-to (Base Metal) D6076 — Implant Crown — Base Metal D6082 — Implant-Supported Crown Repair, By Report D6097 — Abutment-Supported Retainer (Removable) D6243 — Bridge Pontic — Porcelain Fused to Titanium D6607 — Bridge Retainer — Inlay, Cast Noble Metal (3+ Surf) D6083 — Implant-Supported Prosthesis Repair, By Report D6085 — Provisional Implant Crown D6106 — Bone Graft — Mandibular Symphysis D6784 — Bridge Retainer — ¾ Titanium D6011 — Second Stage Implant Surgery D6059 — Implant Abutment — Custom, By Report D6060 — Implant Abutment — Prefabricated (Noble Metal) D6111 — Implant Bridge Retainer — Porcelain Fused to BM D6112 — Implant Bridge Retainer — Porcelain/Ceramic D6605 — Bridge Retainer — Inlay, Cast Base Metal (3+ Surf) D6615 — Bridge Retainer — Onlay, Cast Noble Metal (3+ Surf) D6013 — Surgical Placement — Mini Implant D6058 — Implant Abutment — Prefabricated D6064 — Implant Abutment — Prefabricated (Titanium) D6067 — Implant Crown — High Noble Metal D6077 — Implant Crown — Noble Metal D6088 — Implant Bridge Retainer — Resin D6180 — Implant-Supported Partial Denture (Upper) D6613 — Bridge Retainer — Onlay, Cast Base Metal (3+ Surf) D6790 — Bridge Retainer — Full Cast High Noble Metal D6950 — Precision Attachment D6055 — Dental Implant-Supported Connecting Bar D6065 — Implant Crown — Porcelain/Ceramic D6072 — Implant Bridge Pontic — Porcelain Fused to Metal D6102 — Bone Graft — Debridement of Peri-Implant Defect D6212 — Bridge Pontic — Cast Noble Metal D6549 — Retainer — Resin for Resin-Bonded Bridge D6608 — Bridge Retainer — Onlay, Porcelain/Ceramic (2 Surf) D6751 — Bridge Retainer — Porcelain Fused to Base Metal D6791 — Bridge Retainer — Full Cast Base Metal D6792 — Bridge Retainer — Full Cast Noble Metal D6073 — Implant Bridge Pontic — Cast High Noble Metal D6104 — Bone Graft — Implant Repair (Each Add'l Site) D6121 — Implant-Supported Retainer — FPD (Noble) D6210 — Bridge Pontic — Cast High Noble Metal D6603 — Bridge Retainer — Inlay, Cast High Noble Metal (3+ Surf) D6740 — Bridge Retainer — Porcelain/Ceramic D6056 — Prefabricated Implant Abutment D6071 — Implant Crown — Cast Base Metal D6084 — Custom Implant Abutment (Porcelain/Ceramic) D6089 — Implant Abutment Modification D6107 — Bone Graft — From Extra-Oral Donor Site D6122 — Implant-Supported Retainer — FPD (Base) D6192 — Semi-Precision Abutment — Removal D6195 — Implant-Supported Connector Bar (Modification) D6545 — Retainer — Cast Metal for Resin-Bonded Bridge D6548 — Retainer — Porcelain/Ceramic for Resin-Bonded Bridge D6601 — Bridge Retainer — Inlay, Porcelain/Ceramic (3+ Surf) D6720 — Bridge Retainer — Resin with High Noble Metal D6722 — Bridge Retainer — Resin with Noble Metal D6750 — Bridge Retainer — Porcelain Fused to High Noble Metal D6752 — Bridge Retainer — Porcelain Fused to Noble Metal D6793 — Bridge Retainer — Full Cast Titanium D6012 — Surgical Placement — Interim Implant Body D6086 — Implant Crown — Resin D6091 — Implant Repair — Abutment Replacement D6101 — Debridement of Peri-Implant Defect — Surgical D6211 — Bridge Pontic — Cast Base Metal D6245 — Bridge Pontic — Porcelain/Ceramic D6610 — Bridge Retainer — Onlay, Cast High Noble Metal (2 Surf) D6783 — Bridge Retainer — ¾ Porcelain/Ceramic D6051 — Interim Implant Abutment D6242 — Bridge Pontic — Porcelain Fused to Noble Metal D6280 — Bridge Pontic — Resin/Acrylic Denture Tooth D6096 — Remove Broken Implant Retaining Screw D6190 — Radiographic/Surgical Implant Index (Per Arch) D6049 — Removable Implant Prosthesis, By Report D6099 — Implant-Supported Retainer for FPD (Ceramic) D6080 — Implant Maintenance — Cleaning/Inspection D6087 — Implant Bridge Pontic — Resin D6193 — Stress-Breaking Abutment — Placement D6093 — Re-cement/Re-bond Implant Bridge D6115 — Implant Bridge Retainer — Cast Metal (BM) D6198 — Remove Interim Implant Body D6930 — Re-cement/Re-bond Bridge D6980 — Fixed Partial Denture Repair, By Report D6092 — Re-cement/Re-bond Implant Crown D6081 — Scaling/Debridement of Implant (Moderate/Severe) D6094 — Implant Abutment — Titanium/Ti Alloy (Custom) D6114 — Implant Bridge Retainer — Cast Metal (NM) D6196 — Implant Provisional Crown (Implant Placement Visit) D6205 — Bridge Pontic — Indirect Composite/Resin D6710 — Bridge Retainer — Indirect Resin

D7210 — Extraction — Surgical (Erupted Tooth) D7320 — Alveoloplasty — Without Extractions (Per Quad) D7509 — Marsupialization of Cyst D7962 — Lingual Frenectomy D7340 — Vestibuloplasty — Ridge Extension D7350 — Vestibuloplasty — Ridge Extension (w/ Graft) D7957 — Guided Bone Regeneration — Non-Resorbable Membrane D7284 — Excisional Biopsy — Bone D7994 — Surgical Placement — Bone-Fixation Plate D7290 — Surgical Repositioning of Teeth D7510 — Incision and Drainage — Intraoral (Soft Tissue) D7241 — Extraction — Completely Bony Impacted (Complicated) D7270 — Tooth Reimplantation/Stabilization D7260 — Oroantral Fistula Closure D7471 — Removal of Lateral Exostosis D7961 — Buccal/Labial Frenectomy D7251 — Coronectomy — Intentional Partial Tooth Removal D7283 — Placement of Device for Eruption of Impacted Tooth D7296 — Corticotomy — One to Three Tooth Spaces D7451 — Removal of Benign Odontogenic Cyst > 1.25 cm D7511 — Incision and Drainage — Intraoral (Soft Tissue, Complicated) D7520 — Incision and Drainage — Extraoral (Soft Tissue) D7230 — Extraction — Partially Bony Impacted Tooth D7261 — Primary Closure of Sinus Perforation D7272 — Tooth Transplantation D7280 — Surgical Exposure of Impacted Tooth (Orthodontic) D7286 — Incisional Biopsy — Oral Tissue (Soft) D7287 — Exfoliative Cytological Sample Collection D7310 — Alveoloplasty — With Extractions (Per Quad) D7410 — Excision of Benign Lesion ≤ 1.25 cm D7880 — Occlusal Orthotic Device — By Report D7939 — Unspecified Surgical Procedure, By Report D7950 — Osseous/Osteoperiosteal Graft — Mandible/Maxilla D7252 — Tooth Removal of Impacted Tooth (Soft Tissue) D7460 — Removal of Benign Non-Odontogenic Cyst ≤ 1.25 cm D7472 — Removal of Torus Palatinus D7953 — Bone Replacement Graft — Ridge Preservation D7450 — Removal of Benign Odontogenic Cyst ≤ 1.25 cm D7952 — Sinus Augmentation via Lateral Open Approach D7955 — Repair of Maxillofacial Soft/Hard Tissue Defect D7970 — Excision of Hyperplastic Tissue — Per Arch D7971 — Excision of Pericoronal Gingiva D7291 — Transseptal Fiberotomy D7473 — Removal of Torus Mandibularis D7285 — Incisional Biopsy — Oral Tissue (Hard) D7485 — Reduction of Osseous Tuberosity D7951 — Sinus Augmentation with Bone Graft D7956 — Guided Bone Regeneration — Edentulous Area D7220 — Extraction — Soft Tissue Impacted Tooth D7250 — Extraction — Residual Root Removal D7282 — Mobilization of Erupted/Malpositioned Tooth D7311 — Alveoloplasty — With Extractions (1–3 Teeth) D7550 — Partial Ostectomy/Sequestrectomy D7972 — Surgical Reduction of Fibrous Tuberosity D7111 — Extraction — Coronal Remnants (Primary Tooth) D7240 — Extraction — Completely Bony Impacted Tooth D7288 — Brush Biopsy — Transepithelial Sample Collection D7321 — Alveoloplasty — Without Extractions (1–3 Teeth) D7881 — Occlusal Orthotic Device — Adjustment D7912 — Complicated Suture (> 5 cm) D7921 — Collection/Application of Autologous Blood Concentrate D7297 — Corticotomy — Four or More Tooth Spaces D7963 — Frenuloplasty D7140 — Extraction — Erupted Tooth or Exposed Root D7294 — Surgical Placement — Temporary Anchorage (Requiring Flap, Bone) D7300 — Removal of Foreign Body from Mucosa/Skin/Subcut D7411 — Excision of Benign Lesion > 1.25 cm D7413 — Excision of Malignant Lesion ≤ 1.25 cm D7530 — Removal of Foreign Body — Skin/Areolar Tissue D7540 — Removal of Reaction-Producing Foreign Body (Musculoskeletal) D7670 — Alveolus — Closed Reduction/Stabilization D7910 — Suture of Wound (Up to 5 cm) D7922 — Placement of Intra-Socket Biological Dressing D7944 — Osteotomy — Segmented/Subapical D7995 — Synthetic Graft — Mandible or Facial Bones D7997 — Appliance Removal

D8040 — Limited Orthodontic — Adult Dentition D8696 — Repair of Orthodontic Appliance D8070 — Comprehensive Orthodontic — Transitional Dentition D8030 — Limited Orthodontic — Adolescent Dentition D8080 — Comprehensive Orthodontic — Adolescent Dentition D8091 — Comprehensive Orthodontic — By Report D8670 — Periodic Orthodontic Treatment Visit D8671 — Periodic Orthodontic Treatment Visit (As Part of Contract) D8704 — Replacement of Lost/Broken Retainer, By Report D8010 — Limited Orthodontic — Primary Dentition D8697 — Re-cement/Re-bond Fixed Retainer (Maxillary) D8090 — Comprehensive Orthodontic — Adult Dentition D8220 — Fixed Appliance Therapy D8680 — Orthodontic Retention — Removable Appliance D8681 — Orthodontic Retention — Fixed Appliance D8701 — Repair of Fixed Retainer (Includes Re-attachment) D8703 — Replacement of Lost/Broken Retainer (Fixed) D8020 — Limited Orthodontic — Transitional Dentition D8210 — Removable Appliance Therapy D8660 — Pre-Orthodontic Treatment Exam D8698 — Re-cement/Re-bond Fixed Retainer (Mandibular) D8702 — Replacement of Lost/Broken Retainer (Removable)

D9222 — Deep Sedation/General Anesthesia — First 15 min D9247 — Non-IV Moderate Conscious Sedation — Supplemental D9129 — Metal-Based Temporization/Splinting (Each Additional) D9225 — Deep Sedation/General Anesthesia — Each Add'l 15 min (Dentist) D9243 — Intravenous Moderate Sedation — Each Add'l 15 min D9974 — Internal Bleaching — Per Tooth D9110 — Palliative (Emergency) Treatment D9224 — Deep Sedation/General Anesthesia — First 15 min (Dentist) D9440 — Office Visit — After Regular Hours D9613 — Infiltration of Sustained-Release Therapeutic Drug D9938 — Adjustment of Appliance (Obstructive Sleep Apnea) D9944 — Occlusal Guard — Hard Appliance (Full Arch) D9952 — Occlusal Adjustment — Complete D9950 — Occlusion Analysis — Mounted Case D9223 — Deep Sedation/General Anesthesia — Each Add'l 15 min D9612 — Therapeutic Parenteral Drug — Two+ Administrations D9239 — Intravenous Moderate Sedation — First 15 min D9420 — Hospital or ASC Call D9410 — House/Extended Care Facility Call D9972 — External Bleaching — Per Arch D9994 — Dental Case Management — Patient Education D9246 — Non-IV Moderate Conscious Sedation — Each Add'l 15 min D9941 — Fabrication of Athletic Mouthguard D9945 — Occlusal Guard — Soft Appliance (Full Arch) D9215 — Local Anesthesia (In Conjunction w/ Procedure) D9219 — Evaluation for Moderate Sedation D9934 — Re-cement/Re-bond Fixed Retainer D9244 — Non-IV Moderate Conscious Sedation (By Non-Treating Dentist) D9610 — Therapeutic Parenteral Drug — Single Admin D9930 — Treatment of Complications (Post-Surgical) D9128 — Metal-Based Temporization/Splinting (Single Tooth) D9212 — Trigeminal Division Block Anesthesia D9245 — Non-IV Moderate Conscious Sedation — First 15 min D9935 — Device Repair, By Report D9951 — Occlusal Adjustment — Limited D9973 — External Bleaching — Per Tooth D9210 — Local Anesthesia (Not w/ Procedure) D9230 — Inhalation Analgesia (Nitrous Oxide) D9310 — Consultation — Specialist/Dentist D9311 — Consultation — With Another Dentist/Physician D9630 — Drugs or Medicaments (Not Otherwise Classified) D9920 — Behavior Management — By Report D9943 — Occlusal Guard — By Report D9946 — Occlusal Guard — Hard Appliance (Partial Arch) D9986 — Missed Appointment D9430 — Office Visit for Observation (No Services) D9911 — Application of Desensitizing Resin D9932 — Cleaning/Inspection of Removable Appliance D9936 — Replacement Device/Appliance — Obstructive Sleep Apnea D9942 — Repair/Reline of Occlusal Guard D9970 — Enamel Microabrasion D9975 — External Bleaching (Home Application, Per Arch)