2020/12/16 Council Agenda Packet

D5865 Overdenture - complete mandibular D5866 Overdenture - partial mandibular D5986 Fluoride gel carrier 7. Prosthodontics - Fixed D6210 Pontic - cast high noble metal D6240 Pontic - porcelain fused to high noble metal D6241 Pontic - porcelain fused to predominantly base metal D6545 Retainer - cast metal for resin bonded fixed prosthesis D6720 Retainer crown - resin with high noble metal D6750 Retainer crown - porcelain fused to high noble metal D6780 Retainer crown - % cast high noble metal D6790 Retainer crown - full cast high noble metal D6930 Re -cement or re -bond fixed partial denture D6980 Fixed partial denture repair necessitated by restorative material failure 8. Oral D7111 D7140 D7210 D7220 D7230 D7240 D7241 D7250 D7260 D7261 D7270 D7280 D7283 D7291 D7310 D7311 D7320 D7321 D7340 D7350 D7471 D7510 D7520 D7530 D7540 D7550 D7670 D7910 D7911 D7953 D7960 D7970 Surgery Extraction, corona) remnants - primary tooth Extraction, erupted tooth or exposed root (elevation and/or forceps removal) Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated Removal of impacted tooth - soft tissue Removal of impacted tooth - partially bony Removal of impacted tooth - completely bony Removal of impacted tooth - completely bony, with unusual surgical complications Removal of residual tooth roots (cutting procedure) Oroantral fistula closure P rimary closure of a sinus perforation Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth Exposure of an unerupted tooth P lacement of device to facilitate eruption of impacted tooth Transseptal fiberotomy/supra crestal fiberotomy, by report Alveoloplasty in conjunction with extractions - 4 or more teeth or tooth spaces, per quadrant Alveoloplasty in conjunction with extractions - 1 to 3 teeth or tooth spaces, per quadrant Alveoloplasty not in conjunction with extractions - 4 or more teeth or tooth spaces, per quadrant Alveoloplasty not in conjunction with extractions - 1 to 3 teeth or tooth spaces, per quadrant Vestibuloplasty - ridge extension (secondary epithelialization) Vestibuloplasty - ridge extension (including soft tissue grafts muscle reattachment, revision of soft tissue attachment and management of hypertrophied and hyperplastic tissue) Removal of lateral exostosis (maxilla or mandible) Incision & drainage of abscess - intraoral soft tissue Incision & drainage of abscess - extraoral soft tissue Removal of foreign body from mucosa, skin or subcutaneous alveolar tissue Removal of reaction producing foreign bodies, musculoskeletal system Partial ostectomy/sequestrectomy for removal of non -vital bone Alveolus - closed reduction, may include stabilization of teeth S uture of recent small wounds up to 5 cm Complicated suture - up to 5 cm Bone replacement graft for ridge preservation per site Frenulectomy - also known as frenectomy or frenotomy - separate procedure not incidental to another Excision of hyperplastic tissue - per arch Current Dental Terminology (CDT) 0 2020 American Dental Association. All rights reserved. 001 L-WA811(5/20) $300 $300 $0 $150 $150 $150 $150 $150 $150 $150 $150 $0 $0 $10 $10 $85 $85 $85 $85 $85 $85 $85 $85 $85 $85 $85 $85 $0 $0 $0 $0 $85 $85 $85 $0 $0 $0 $0 $0 $0 $0 $0 $85 $85 $85 27