Dental Reimbursement Rates in Wyoming

D0322 — Tomographic Survey D0251 — Extraoral — Posterior Dental X-Ray D0273 — Bitewing X-Rays — Three Films D0277 — Vertical Bitewing X-Rays (7–8 Films) D0310 — Sialography D0320 — TMJ Arthrogram

D1120 — Child Prophylaxis D1526 — Space Maintainer — Removable, Bilateral (Maxillary) D1551 — Re-cement/Re-bond Space Maintainer (Unilateral) D1553 — Re-cement/Re-bond Space Maintainer (Bilateral, Mand) D1556 — Removal of Fixed Space Maintainer (Unilateral) D1557 — Removal of Fixed Space Maintainer (Bilateral, Max)

D2790 — Crown — Full Cast High Noble Metal D2510 — Inlay — Metallic, 1 Surface D2721 — Crown — Resin with Base Metal D2722 — Crown — Resin with Noble Metal D2751 — Crown — Porcelain Fused to Base Metal D2752 — Crown — Porcelain Fused to Noble Metal D2780 — Crown — ¾ Cast High Noble Metal D2929 — Prefabricated Porcelain/Ceramic Crown — Permanent D2161 — Amalgam Filling — 4+ Surfaces, Primary/Permanent D2330 — Composite Filling — 1 Surface, Anterior D2390 — Composite Crown — Anterior, Primary D2392 — Composite Filling — 2 Surfaces, Posterior D2410 — Gold Foil — 1 Surface D2542 — Onlay — Metallic, 2 Surfaces D2544 — Onlay — Metallic, 4+ Surfaces D2610 — Inlay — Porcelain/Ceramic, 1 Surface D2630 — Inlay — Porcelain/Ceramic, 3+ Surfaces D2642 — Onlay — Porcelain/Ceramic, 2 Surfaces D2650 — Inlay — Composite/Resin, 1 Surface D2662 — Onlay — Composite/Resin, 2 Surfaces D2663 — Onlay — Composite/Resin, 3 Surfaces D2710 — Crown — Resin (Indirect) D2720 — Crown — Resin with High Noble Metal D2753 — Crown — Porcelain Fused to Titanium D2791 — Crown — Full Cast Base Metal D2792 — Crown — Full Cast Noble Metal D2920 — Re-cement/Re-bond Crown D2928 — Prefabricated Porcelain/Ceramic Crown — Primary D2931 — Prefabricated Stainless Steel Crown — Permanent D2933 — Prefabricated SS Crown with Resin Window D2934 — Prefabricated Esthetic Coated SS Crown — Primary D2953 — Post and Core — Each Additional (Cast) D2956 — Prefabricated Post and Core — Additional D2957 — Each Additional Prefabricated Post D2960 — Labial Veneer — Resin (Chair-side) D2976 — Stump Buildup with Pins D2981 — Inlay Repair, By Report D2983 — Veneer Repair, By Report D2989 — Unspecified Restorative Procedure, By Report

D3320 — Root Canal — Premolar (Excluding Final Restoration) D3355 — Pulpal Regeneration — Initial Visit D3430 — Retrograde Filling — Per Root D3431 — Biologically-Based Root Treatment D3222 — Partial Pulpotomy for Apexogenesis — Permanent D3230 — Pulpal Therapy — Anterior, Primary D3310 — Root Canal — Anterior (Excluding Final Restoration) D3346 — Retreatment — Anterior D3348 — Retreatment — Molar D3351 — Apexification/Recalcification — Initial Visit D3357 — Pulpal Regeneration — Final Visit D3410 — Apicoectomy — Anterior D3426 — Apicoectomy — Each Additional Root D3450 — Root Amputation — Per Root D3470 — Intentional Reimplantation D3471 — Surgical Repair — Root Resorption (Anterior) D3472 — Surgical Repair — Root Resorption (Premolar) D3473 — Surgical Repair — Root Resorption (Molar) D3501 — Surgical Exposure for Canal Access D3502 — Surgical Perforation Repair D3503 — Surgical Root Repair — Anterior D3920 — Hemisection (Not Root Canal/Restoration) D3921 — Decoronation/Intentional Submergence

D4210 — Gingivectomy/Gingivoplasty — 4+ Teeth (Per Quad) D4212 — Gingivectomy/Gingivoplasty (Restorative, Per Tooth) D4231 — Anatomical Crown Exposure — 1–3 Teeth (Per Quad) D4240 — Gingival Flap Surgery — 4+ Teeth (Per Quad) D4261 — Osseous Surgery — 1–3 Teeth (Per Quad) D4263 — Bone Replacement Graft — First Site (Per Quad) D4264 — Bone Replacement Graft — Each Additional Site D4267 — Guided Tissue Regeneration — Non-Resorbable Barrier D4273 — Autogenous Connective Tissue Graft (First Tooth) D4274 — Distal/Proximal Wedge Procedure D4277 — Free Soft Tissue Graft (First Tooth) D4283 — Autogenous Connective Tissue Graft (Each Add'l Tooth) D4286 — Combined Connective Tissue Graft (Each Add'l Tooth) D4323 — Splint — Extracoronal (Natural Teeth) D4341 — Scaling and Root Planing — 4+ Teeth (Per Quad) D4342 — Scaling and Root Planing — 1–3 Teeth (Per Quad) D4355 — Full Mouth Debridement D4920 — Unscheduled Dressing Change

D5211 — Upper Partial Denture — Resin Base (w/ Clasps/Rests) D5282 — Removable Unilateral Partial Denture — 1 Piece (Metal) D5286 — Removable Unilateral Partial Denture — 2 Piece (Metal) D5711 — Rebase Complete Lower Denture D5750 — Reline Complete Upper Denture (Lab) D5765 — Soft Liner for Complete or Partial Denture D5866 — Overdenture — Partial (Implant Supported) D5877 — Replacement of Locator Male, By Report D5110 — Complete Upper Denture D5140 — Immediate Lower Denture D5212 — Lower Partial Denture — Resin Base (w/ Clasps/Rests) D5214 — Lower Partial Denture — Cast Metal Framework D5221 — Immediate Upper Partial Denture — Resin Base D5222 — Immediate Lower Partial Denture — Resin Base D5223 — Immediate Upper Partial Denture — Cast Metal D5225 — Upper Partial Denture — Flexible Base D5226 — Lower Partial Denture — Flexible Base D5227 — Immediate Upper Partial Denture — Flexible Base D5283 — Removable Unilateral Partial Denture — 1 Piece (Resin) D5411 — Adjust Complete Lower Denture D5511 — Repair Broken Complete Denture Base (Upper) D5611 — Repair Resin Partial Denture Base (Upper) D5670 — Replace Teeth & Acrylic on Metal Framework D5671 — Replace All Teeth & Acrylic on Cast Metal Framework D5710 — Rebase Complete Upper Denture D5720 — Rebase Upper Partial Denture D5731 — Reline Complete Lower Denture (Chair-side) D5740 — Reline Upper Partial Denture (Chair-side) D5760 — Reline Upper Partial Denture (Lab) D5810 — Interim Complete Upper Denture D5811 — Interim Complete Lower Denture D5821 — Interim Partial Lower Denture D5850 — Tissue Conditioning (Upper) D5863 — Overdenture — Complete (Implant/Root Supported) D5864 — Overdenture — Partial (Implant/Root Supported) D5878 — Add Wrought Wire Clasp (Tooth-Supported)

D6058 — Implant Abutment — Prefabricated D6063 — Implant Abutment — Cast-to (Base Metal) D6073 — Implant Bridge Pontic — Cast High Noble Metal D6077 — Implant Crown — Noble Metal D6722 — Bridge Retainer — Resin with Noble Metal D6782 — Bridge Retainer — ¾ Cast Noble Metal D6064 — Implant Abutment — Prefabricated (Titanium) D6075 — Implant Crown — Porcelain Fused to Titanium D6123 — Implant-Supported Retainer — FPD (Titanium) D6251 — Bridge Pontic — Resin with Base Metal D6606 — Bridge Retainer — Inlay, Cast Noble Metal (2 Surf) D6612 — Bridge Retainer — Onlay, Cast Base Metal (2 Surf) D6752 — Bridge Retainer — Porcelain Fused to Noble Metal D6783 — Bridge Retainer — ¾ Porcelain/Ceramic D6010 — Surgical Placement — Endosteal Implant Body D6011 — Second Stage Implant Surgery D6040 — Surgical Placement — Eposteal Implant D6051 — Interim Implant Abutment D6055 — Dental Implant-Supported Connecting Bar D6056 — Prefabricated Implant Abutment D6057 — Custom Fabricated Implant Abutment D6062 — Implant Abutment — Cast-to (Noble Metal) D6065 — Implant Crown — Porcelain/Ceramic D6066 — Implant Crown — Porcelain Fused to Metal D6068 — Implant Abutment — Prefabricated D6069 — Implant Crown — Titanium D6071 — Implant Crown — Cast Base Metal D6074 — Implant Bridge Pontic — Porcelain/Ceramic D6076 — Implant Crown — Base Metal D6080 — Implant Maintenance — Cleaning/Inspection D6083 — Implant-Supported Prosthesis Repair, By Report D6097 — Abutment-Supported Retainer (Removable) D6098 — Implant-Supported Retainer (Removable) D6099 — Implant-Supported Retainer for FPD (Ceramic) D6106 — Bone Graft — Mandibular Symphysis D6112 — Implant Bridge Retainer — Porcelain/Ceramic D6113 — Implant Bridge Retainer — Cast Metal (HNM) D6120 — Implant-Supported Retainer — FPD (High Noble) D6122 — Implant-Supported Retainer — FPD (Base) D6180 — Implant-Supported Partial Denture (Upper) D6191 — Semi-Precision Abutment — Placement D6192 — Semi-Precision Abutment — Removal D6195 — Implant-Supported Connector Bar (Modification) D6196 — Implant Provisional Crown (Implant Placement Visit) D6198 — Remove Interim Implant Body D6212 — Bridge Pontic — Cast Noble Metal D6240 — Bridge Pontic — Porcelain Fused to High Noble Metal D6241 — Bridge Pontic — Porcelain Fused to Base Metal D6243 — Bridge Pontic — Porcelain Fused to Titanium D6250 — Bridge Pontic — Resin with High Noble Metal D6253 — Provisional Bridge Pontic D6280 — Bridge Pontic — Resin/Acrylic Denture Tooth D6548 — Retainer — Porcelain/Ceramic for Resin-Bonded Bridge D6600 — Bridge Retainer — Inlay, Porcelain/Ceramic (2 Surf) D6603 — Bridge Retainer — Inlay, Cast High Noble Metal (3+ Surf) D6607 — Bridge Retainer — Inlay, Cast Noble Metal (3+ Surf) D6609 — Bridge Retainer — Onlay, Porcelain/Ceramic (3+ Surf) D6611 — Bridge Retainer — Onlay, Cast High Noble Metal (3+ Surf) D6613 — Bridge Retainer — Onlay, Cast Base Metal (3+ Surf) D6615 — Bridge Retainer — Onlay, Cast Noble Metal (3+ Surf) D6720 — Bridge Retainer — Resin with High Noble Metal D6750 — Bridge Retainer — Porcelain Fused to High Noble Metal D6780 — Bridge Retainer — ¾ Cast High Noble Metal D6781 — Bridge Retainer — ¾ Cast Base Metal D6784 — Bridge Retainer — ¾ Titanium D6791 — Bridge Retainer — Full Cast Base Metal D6940 — Bridge Repair, By Report

D7260 — Oroantral Fistula Closure D7956 — Guided Bone Regeneration — Edentulous Area D7962 — Lingual Frenectomy D7210 — Extraction — Surgical (Erupted Tooth) D7230 — Extraction — Partially Bony Impacted Tooth D7240 — Extraction — Completely Bony Impacted Tooth D7241 — Extraction — Completely Bony Impacted (Complicated) D7250 — Extraction — Residual Root Removal D7270 — Tooth Reimplantation/Stabilization D7272 — Tooth Transplantation D7285 — Incisional Biopsy — Oral Tissue (Hard) D7286 — Incisional Biopsy — Oral Tissue (Soft) D7288 — Brush Biopsy — Transepithelial Sample Collection D7321 — Alveoloplasty — Without Extractions (1–3 Teeth) D7340 — Vestibuloplasty — Ridge Extension D7450 — Removal of Benign Odontogenic Cyst ≤ 1.25 cm D7472 — Removal of Torus Palatinus D7957 — Guided Bone Regeneration — Non-Resorbable Membrane D7970 — Excision of Hyperplastic Tissue — Per Arch D7971 — Excision of Pericoronal Gingiva D7972 — Surgical Reduction of Fibrous Tuberosity

D8660 — Pre-Orthodontic Treatment Exam

D9225 — Deep Sedation/General Anesthesia — Each Add'l 15 min (Dentist) D9222 — Deep Sedation/General Anesthesia — First 15 min D9224 — Deep Sedation/General Anesthesia — First 15 min (Dentist) D9243 — Intravenous Moderate Sedation — Each Add'l 15 min D9420 — Hospital or ASC Call D9440 — Office Visit — After Regular Hours D9945 — Occlusal Guard — Soft Appliance (Full Arch) D9952 — Occlusal Adjustment — Complete D9974 — Internal Bleaching — Per Tooth