Laserfiche WebLink
D2150 Amalgam - 2 surfaces, primary or permanent <br />D2160 Amalgam - 3 surfaces, primary or permanent <br />D2161 Amalgam - 4 or more surfaces, primary or permanent <br />D2330 Resin - based composite - 1 surface, anterior <br />D2331 Resin - based composite - 2 surfaces, anterior <br />D2332 Resin - based composite - 3 surfaces, anterior <br />D2335 Resin - based composite - 4 or more surfaces involving <br />D2390 Resin - based composite crown, anterior <br />D2391 Resin - based composite - 1 surface, posterior <br />D2392 Resin - based composite - 2 surfaces posterior <br />D2393 Resin - based composite - 3 surfaces posterior <br />D2394 Resin - based composite - 4 or more surfaces, posterior <br />D2510 Inlay - metallic - 1 surface <br />D2520 Inlay - metallic - 2 surfaces <br />D2530 Inlay - metallic - 3 or more surfaces <br />D2542 Onlay - metallic - 2 surfaces <br />D2543 Onlay - metallic - 3 surfaces <br />D2544 Onlay - metallic - 4 or more surfaces <br />D2610 Inlay - porcelain/ceramic - 1 surface <br />D2620 Inlay - porcelain/ceramic - 2 surfaces <br />D2630 Inlay - porcelain/ceramic - 3 or more surfaces <br />D2642 Onlay - porcelain/ceramic - 2 surfaces <br />D2643 Onlay - porcelain/ceramic - 3 surfaces <br />D2644 Onlay - porcelain/ceramic - 4 or more surfaces <br />3. Crowns <br />incisal angle (anterior) <br />D2710 Crown - resin based composite (indirect) <br />D2740 Crown - porcelain/ceramic <br />D2750 Crown - porcelain fused to high noble metal <br />D2780 Crown -3/4 cast high noble metal <br />D2790 Crown - full cast high noble metal <br />D2910 Re -cement or re -bond inlay, onlay, or partial coverage restoration <br />D2920 Re cement or re -bond crown <br />D2930 Prefabricated stainless steel <br />D2931 Prefabricated stainless steel <br />D2932 Prefabricated resin crown <br />D2933 Prefabricated stainless steel <br />D2940 Protective restoration <br />D2950 Core buildup, including any pins when required <br />D2951 Pin retention - per tooth, in addition to restoration <br />D2954 Prefabricated post and core in addition to crown <br />D2955 Post removal <br />D2957 Each additional prefabricated post - same tooth <br />D2975 Coping <br />D2980 Crown repair necessitated by restorative material failure <br />4. Endodontics <br />D3110 <br />D3120 <br />D3220 <br />D3221 <br />D3230 <br />D3240 <br />D3310 <br />D3320 <br />crown - primary tooth <br />crown - permanent tooth <br />crown with resin window <br />P ulp cap - direct (excluding final restoration) <br />P ulp cap - indirect (excluding final restoration) <br />Therapeutic pulpotomy (excluding final restoration) - removal of pulp corona) to the <br />dentinocemental junction and application of medicament <br />P ulpal debridement, primary and permanent teeth <br />P ulpal therapy (resorbable filling) - anterior, primary tooth (excluding final restoration) <br />P ulpal therapy (resorbable filling) - posterior primary tooth (excluding final restoration) <br />Endodontic therapy, anterior tooth (excluding final restoration) <br />Endodontic therapy, premolar tooth (excluding final restoration) <br />$25 <br />$25 <br />$25 <br />$25 <br />$25 <br />$25 <br />$25 <br />$25 <br />$25 <br />$25 <br />$25 <br />$25 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$150 <br />$0 <br />$0 <br />$0 <br />$0 <br />so <br />so <br />$0 <br />$0 <br />$0 <br />$0 <br />$0 <br />$0 <br />$0 <br />$0 <br />so <br />so <br />$0 <br />$0 <br />so <br />$0 <br />$75 <br />$100 <br />Current Dental Terminology (CDT) 0 2020 American Dental Association. <br />All rights reserved. <br />001 L-WA811(5/20) 24 <br />