20 Miss. Code R. § 2-II

Current through June 25, 2024

Section 20-2-II - GUIDELINES

A. Treatments provided for work-related dental injuries not specifically contained in the Fee Schedule should be billed using CDT code D9999 "Unspecified Adjunctive Procedure, By Report."

B.By Report (BR). "BR" in the Amount column indicates services that are too new, unusual, or variable in the nature of their performance to permit the assignment of a definable fee. Such services should be substantiated by documentation submitted with the bill. Sufficient information should be included to permit proper identification and a sound evaluation.

C.Dental Providers: The following dental providers, licensed in the state where they practice, may be paid for dental services:

1. Dentists

2. Oral and maxillofacial surgeons

3. Orthodontists

4. Hospitals

5. Dental clinics

Services provided by other dental practitioners, including hygienists and dental assistants, must be billed by the licensed dentist, orthodontist or oral surgeon overseeing these practitioners.

D.Laboratory Procedures: Reimbursement for laboratory procedures is included in the maximum allowable reimbursement for the associated dental procedure.

E.Modifiers: Dental codes do not contain modifiers.

Code	Description	Amount
D0120	PERIODIC ORAL EVALUATION - ESTABLISHED PATIENT	49.00
D0140	LIMITED ORAL EVALUATION - PROBLEM FOCUSED	72.00
D0145	ORAL EVALUATION FOR A PATIENT UNDER THREE YEARS OF AGE AND COUNSELING WITH PRIMARY CAREGIVER	65.00
D0150	COMPREHENSIVE ORAL EVALUATION - NEW OR ESTABLISHED PATIENT	79.00
D0160	DETAILED AND EXTENSIVE ORAL EVALUATION - PROBLEM FOCUSED, BY REPORT	BR
D0170	RE-EVALUATION - LIMITED, PROBLEM FOCUSED (ESTABLISHED PATIENT; NOT POST-OPERATIVE VISIT)	69.00
D0171	RE-EVALUATION - POST-OPERATIVE OFFICE VISIT	64.00
D0180	COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT	101.00
D0190	SCREENING OF A PATIENT	40.00
D0191	ASSESSMENT OF A PATIENT	30.00
D0210	INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES	135.00
D0220	INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE	28.00
D0230	INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE	24.00
D0240	INTRAORAL - OCCLUSAL RADIOGRAPHIC IMAGE	35.00
D0250	EXTRA-ORAL - 2D PROJECTION RADIOGRAPHIC IMAGE CREATED USING A STATIONARY RADIATION SOURCE, AND DETECTOR	49.00
D0251	EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE	35.00
D0270	BITEWING - SINGLE RADIOGRAPHIC IMAGE	29.00
D0272	BITEWINGS - TWO RADIOGRAPHIC IMAGES	43.00
D0273	BITEWINGS - THREE RADIOGRAPHIC IMAGES	53.00
D0274	BITEWINGS - FOUR RADIOGRAPHIC IMAGES	60.00
D0277	VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES	92.00
D0310	SIALOGRAPHY	413.33
D0320	TEMPOROMANDIBULAR JOINT ARTHROGRAM, INCLUDING INJECTION	730.22
D0321	OTHER TEMPOROMANDIBULAR JOINT RADIOGRAPHIC IMAGES, BY REPORT	BR
D0322	TOMOGRAPHIC SURVEY	592.45
D0330	PANORAMIC RADIOGRAPHIC IMAGE	109.00
D0340	2D CEPHALOMETRIC RADIOGRAPHIC IMAGE - ACQUISITION, MEASUREMENT AND ANALYSIS	99.00
D0350	2D ORAL/FACIAL PHOTOGRAPHIC IMAGE OBTAINED INTRA-ORALLY OR EXTRA-ORALLY	50.00
D0351	3D PHOTOGRAPHIC IMAGE	55.00
D0364	CONE BEAM CT CAPTURE AND INTERPRETATION WITH LIMITED FIELD OF VIEW - LESS THAN ONE WHOLE JAW	195.00
D0365	CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF ONE FULL DENTAL ARCH - MANDIBLE	185.00
D0366	CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF ONE FULL DENTAL ARCH - MAXILLA, WITH OR WITHOUT CRANIUM	318.50
D0367	CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF BOTH JAWS; WITH OR WITHOUT CRANIUM	297.00
D0368	CONE BEAM CT CAPTURE AND INTERPRETATION FOR TMJ SERIES INCLUDING TWO OR MORE EXPOSURES	340.31
D0369	MAXILLOFACIAL MRI CAPTURE AND INTERPRETATION	192.89
D0370	MAXILLOFACIAL ULTRASOUND CAPTURE AND INTERPRETATION	110.22
D0371	SIALOENDOSCOPY CAPTURE AND INTERPRETATION	BR
D0380	CONE BEAM CT IMAGE CAPTURE WITH LIMITED FIELD OF VIEW - LESS THAN ONE WHOLE JAW	85.00
D0381	CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF ONE FULL DENTAL ARCH - MANDIBLE	180.00
D0382	CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF ONE FULL DENTAL ARCH - MAXILLA, WITH OR WITHOUT CRANIUM	321.02
D0383	CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF BOTH JAWS; WITH OR WITHOUT CRANIUM	200.00
D0384	CONE BEAM CT IMAGE CAPTURE FOR TMJ SERIES INCLUDING TWO OR MORE EXPOSURES	344.45
D0385	MAXILLOFACIAL MRI IMAGE CAPTURE	2114.89
D0386	MAXILLOFACIAL ULTRASOUND IMAGE CAPTURE	529.07
D0391	INTERPRETATION OF DIAGNOSTIC IMAGE BY A PRACTITIONER NOT ASSOCIATED WITH CAPTURE OF THE IMAGE, INCLUDING REPORT	BR
D0393	TREATMENT SIMULATION USING 3D IMAGE VOLUME	BR
D0394	DIGITAL SUBTRACTION OF TWO OR MORE IMAGES OR IMAGE VOLUMES OF THE SAME MODALITY	BR
D0395	FUSION OF TWO OR MORE 3D IMAGE VOLUMES OF ONE OR MORE MODALITIES	BR
D0411	HBA1C IN-OFFICE POINT OF SERVICE TESTING	BR
D0412	BLOOD GLUCOSE LEVEL TEST - IN-OFFICE USING A GLUCOSE METER	BR
D0414	LABORATORY PROCESSING OF MICROBIAL SPECIMEN TO INCLUDE CULTURE AND SENSITIVITY STUDIES, PREPARATION AND TRANSMISSION OF WRITTEN REPORT	55.11
D0415	COLLECTION OF MICROORGANISMS FOR CULTURE AND SENSITIVITY	65.00
D0416	VIRAL CULTURE	59.24
D0417	COLLECTION AND PREPARATION OF SALIVA SAMPLE FOR LABORATORY DIAGNOSTIC TESTING	65.00
D0418	ANALYSIS OF SALIVA SAMPLE	65.00
D0422	COLLECTION AND PREPARATION OF GENETIC SAMPLE MATERIAL FOR LABORATORY ANALYSIS AND REPORT	39.96
D0423	GENETIC TEST FOR SUSCEPTIBILITY TO DISEASES - SPECIMEN ANALYSIS	BR
D0425	CARIES SUSCEPTIBILITY TESTS	34.44
D0431	ADJUNCTIVE PRE-DIAGNOSTIC TEST THAT AIDS IN DETECTION OF MUCOSAL ABNORMALITIES INCLUDING PREMALIGNANT AND MALIGNANT LESIONS, NOT TO INCLUDE CYTOLOGY OR BIOPSY PROCEDURES	31.00
D0460	PULP VITALITY TESTS	53.00
D0470	DIAGNOSTIC CASTS	102.00
D0472	ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT	75.78
D0473	ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT	159.82
D0474	ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, INCLUDING ASSESSMENT OF SURGICAL MARGINS FOR PRESENCE OF DISEASE, PREPARATION AND TRANSMISSION OF WRITTEN REPORT	179.11
D0475	DECALCIFICATION PROCEDURE	96.44
D0476	SPECIAL STAINS FOR MICROORGANISMS	93.69
D0477	SPECIAL STAINS, NOT FOR MICROORGANISMS	128.13
D0478	IMMUNOHISTOCHEMICAL STAINS	117.11
D0479	TISSUE IN-SITU HYBRIDIZATION, INCLUDING INTERPRETATION	179.11
D0480	ACCESSION OF EXFOLIATIVE CYTOLOGIC SMEARS, MICROSCOPIC EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT	110.22
D0481	ELECTRON MICROSCOPY	413.33
D0482	DIRECT IMMUNOFLUORESCENCE	137.78
D0483	INDIRECT IMMUNOFLUORESCENCE	137.78
D0484	CONSULTATION ON SLIDES PREPARED ELSEWHERE	206.67
D0485	CONSULTATION, INCLUDING PREPARATION OF SLIDES FROM BIOPSY MATERIAL SUPPLIED BY REFERRING SOURCE	285.20
D0486	LABORATORY ACCESSION OF TRANSEPITHELIAL CYTOLOGIC SAMPLE, MICROSCOPIC EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT	132.27
D0502	OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT	BR
D0600	NON-IONIZING DIAGNOSTIC PROCEDURE CAPABLE OF QUANTIFYING, MONITORING, AND RECORDING CHANGES IN STRUCTURE OF ENAMEL, DENTIN, AND CEMENTUM	25.00
D0601	CARIES RISK ASSESSMENT AND DOCUMENTATION, WITH A FINDING OF LOW RISK	10.00
D0602	CARIES RISK ASSESSMENT AND DOCUMENTATION, WITH A FINDING OF MODERATE RISK	82.67
D0603	CARIES RISK ASSESSMENT AND DOCUMENTATION, WITH A FINDING OF HIGH RISK	82.67
D0999	UNSPECIFIED DIAGNOSTIC PROCEDURE, BY REPORT	BR
D1110	PROPHYLAXIS - ADULT	85.00
D1120	PROPHYLAXIS - CHILD	67.00
D1206	TOPICAL APPLICATION OF FLUORIDE VARNISH	45.00
D1208	TOPICAL APPLICATION OF FLUORIDE - EXCLUDING VARNISH	35.00
D1310	NUTRITIONAL COUNSELING FOR CONTROL OF DENTAL DISEASE	72.00
D1320	TOBACCO COUNSELING FOR THE CONTROL AND PREVENTION OF ORAL DISEASE	46.03
D1330	ORAL HYGIENE INSTRUCTIONS	65.00
D1351	SEALANT - PER TOOTH	54.00
D1352	PREVENTIVE RESIN RESTORATION IN A MODERATE TO HIGH CARIES RISK PATIENT - PERMANENT TOOTH	68.00
D1353	SEALANT REPAIR - PER TOOTH	60.56
D1354	INTERIM CARIES ARRESTING MEDICAMENT APPLICATION - PER TOOTH	31.00
D1510	SPACE MAINTAINER - FIXED - UNILATERAL	328.00
D1516	SPACE MAINTAINER - FIXED - BILATERAL, MAXILLARY	423.94
D1517	SPACE MAINTAINER - FIXED - BILATERAL, MANDIBULAR	423.94
D1520	SPACE MAINTAINER - REMOVABLE - UNILATERAL	339.00
D1526	SPACE MAINTAINER - REMOVABLE - BILATERAL, MAXILLARY	514.79
D1527	SPACE MAINTAINER - REMOVABLE - BILATERAL, MANDIBULAR	514.79
D1550	RE-CEMENT OR RE-BOND SPACE MAINTAINER	84.00
D1555	REMOVAL OF FIXED SPACE MAINTAINER	77.00
D1575	DISTAL SHOE SPACE MAINTAINER - FIXED - UNILATERAL	333.10
D1999	UNSPECIFIED PREVENTIVE PROCEDURE, BY REPORT	BR
D2140	AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT	132.00
D2150	AMALGAM - TWO SURFACES, PRIMARY OR PERMANENT	164.00
D2160	AMALGAM - THREE SURFACES, PRIMARY OR PERMANENT	195.00
D2161	AMALGAM - FOUR OR MORE SURFACES, PRIMARY OR PERMANENT	220.00
D2330	RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR	154.00
D2331	RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR	185.00
D2332	RESIN-BASED COMPOSITE - THREE SURFACES, ANTERIOR	225.00
D2335	RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)	275.00
D2390	RESIN-BASED COMPOSITE CROWN, ANTERIOR	357.00
D2391	RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR	167.00
D2392	RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR	215.00
D2393	RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR	261.00
D2394	RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR	309.00
D2410	GOLD FOIL - ONE SURFACE	301.91
D2420	GOLD FOIL - TWO SURFACES	503.18
D2430	GOLD FOIL - THREE SURFACES	872.18
D2510	INLAY - METALLIC - ONE SURFACE	798.38
D2520	INLAY - METALLIC - TWO SURFACES	905.73
D2530	INLAY - METALLIC - THREE OR MORE SURFACES	1043.94
D2542	ONLAY - METALLIC - TWO SURFACES	1023.81
D2543	ONLAY - METALLIC - THREE SURFACES	1070.77
D2544	ONLAY - METALLIC - FOUR OR MORE SURFACES	1113.71
D2610	INLAY - PORCELAIN/CERAMIC - ONE SURFACE	939.27
D2620	INLAY - PORCELAIN/CERAMIC - TWO SURFACES	991.60
D2630	INLAY - PORCELAIN/CERAMIC - THREE OR MORE SURFACES	1056.01
D2642	ONLAY - PORCELAIN/CERAMIC - TWO SURFACES	1026.49
D2643	ONLAY - PORCELAIN/CERAMIC - THREE SURFACES	992.00
D2644	ONLAY - PORCELAIN/CERAMIC - FOUR OR MORE SURFACES	950.00
D2650	INLAY - RESIN-BASED COMPOSITE - ONE SURFACE	617.24
D2651	INLAY - RESIN-BASED COMPOSITE - TWO SURFACES	735.32
D2652	INLAY - RESIN-BASED COMPOSITE - THREE OR MORE SURFACES	772.89
D2662	ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES	670.91
D2663	ONLAY - RESIN-BASED COMPOSITE - THREE SURFACES	788.99
D2664	ONLAY - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES	845.35
D2710	CROWN - RESIN-BASED COMPOSITE (INDIRECT)	476.35
D2712	CROWN - 3/4 RESIN-BASED COMPOSITE (INDIRECT)	476.35
D2720	CROWN - RESIN WITH HIGH NOBLE METAL	1174.09
D2721	CROWN - RESIN WITH PREDOMINANTLY BASE METAL	1100.29
D2722	CROWN - RESIN WITH NOBLE METAL	1124.45
D2740	CROWN - PORCELAIN/CERAMIC	1072.00
D2750	CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL	998.00
D2751	CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL	957.00
D2752	CROWN - PORCELAIN FUSED TO NOBLE METAL	1017.00
D2780	CROWN - 3/4 CAST HIGH NOBLE METAL	1140.55
D2781	CROWN - 3/4 CAST PREDOMINANTLY BASE METAL	1073.46
D2782	CROWN - 3/4 CAST NOBLE METAL	260.00
D2783	CROWN - 3/4 PORCELAIN/CERAMIC	1145.00
D2790	CROWN - FULL CAST HIGH NOBLE METAL	1100.00
D2791	CROWN - FULL CAST PREDOMINANTLY BASE METAL	898.50
D2792	CROWN - FULL CAST NOBLE METAL	995.00
D2794	CROWN - TITANIUM	1174.09
D2799	PROVISIONAL CROWN- FURTHER TREATMENT OR COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO FINAL IMPRESSION	365.00
D2910	RE-CEMENT OR RE-BOND INLAY, ONLAY, VENEER OR PARTIAL COVERAGE RESTORATION	109.00
D2915	RE-CEMENT OR RE-BOND INDIRECTLY FABRICATED OR PREFABRICATED POST AND CORE	120.00
D2920	RE-CEMENT OR RE-BOND CROWN	95.00
D2921	REATTACHMENT OF TOOTH FRAGMENT, INCISAL EDGE OR CUSP	140.89
D2929	PREFABRICATED PORCELAIN/CERAMIC CROWN - PRIMARY TOOTH	500.00
D2930	PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH	265.00
D2931	PREFABRICATED STAINLESS STEEL CROWN - PERMANENT TOOTH	312.00
D2932	PREFABRICATED RESIN CROWN	322.04
D2933	PREFABRICATED STAINLESS STEEL CROWN WITH RESIN WINDOW	445.00
D2934	PREFABRICATED ESTHETIC COATED STAINLESS STEEL CROWN - PRIMARY TOOTH	308.00
D2940	PROTECTIVE RESTORATION	109.00
D2941	INTERIM THERAPEUTIC RESTORATION - PRIMARY DENTITION	101.98
D2949	RESTORATIVE FOUNDATION FOR AN INDIRECT RESTORATION	101.98
D2950	CORE BUILDUP, INCLUDING ANY PINS WHEN REQUIRED	254.00
D2951	PIN RETENTION - PER TOOTH, IN ADDITION TO RESTORATION	60.00
D2952	POST AND CORE IN ADDITION TO CROWN, INDIRECTLY FABRICATED	366.00
D2953	EACH ADDITIONAL INDIRECTLY FABRICATED POST - SAME TOOTH	201.27
D2954	PREFABRICATED POST AND CORE IN ADDITION TO CROWN	327.00
D2955	POST REMOVAL	175.00
D2957	EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH	136.00
D2960	LABIAL VENEER (RESIN LAMINATE) - CHAIRSIDE	500.00
D2961	LABIAL VENEER (RESIN LAMINATE) - LABORATORY	882.92
D2962	LABIAL VENEER (PORCELAIN LAMINATE) - LABORATORY	1131.00
D2971	ADDITIONAL PROCEDURES TO CONSTRUCT NEW CROWN UNDER EXISTING PARTIAL DENTURE FRAMEWORK	178.00
D2975	COPING	40.00
D2980	CROWN REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE	220.00
D2981	INLAY REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE	187.85
D2982	ONLAY REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE	187.85
D2983	VENEER REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE	187.85
D2990	RESIN INFILTRATION OF INCIPIENT SMOOTH SURFACE LESIONS	145.00
D2999	UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT	BR
D3110	PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)	74.00
D3120	PULP CAP - INDIRECT (EXCLUDING FINAL RESTORATION)	73.00
D3220	THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) - REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT	186.00
D3221	PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH	190.00
D3222	PARTIAL PULPOTOMY FOR APEXOGENESIS - PERMANENT TOOTH WITH INCOMPLETE ROOT DEVELOPMENT	176.00
D3230	PULPAL THERAPY (RESORBABLE FILLING) - ANTERIOR, PRIMARY TOOTH (EXCLUDING FINAL RESTORATION)	280.00
D3240	PULPAL THERAPY (RESORBABLE FILLING) - POSTERIOR, PRIMARY TOOTH (EXCLUDING FINAL RESTORATION)	260.00
D3310	ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)	772.00
D3320	ENDODONTIC THERAPY, PREMOLAR TOOTH (EXCLUDING FINAL RESTORATION)	898.00
D3330	ENDODONTIC THERAPY, MOLAR TOOTH (EXCLUDING FINAL RESTORATION)	1025.00
D3331	TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS	210.00
D3332	INCOMPLETE ENDODONTIC THERAPY; INOPERABLE, UNRESTORABLE OR FRACTURED TOOTH	450.00
D3333	INTERNAL ROOT REPAIR OF PERFORATION DEFECTS	246.40
D3346	RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - ANTERIOR	1010.00
D3347	RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - PREMOLAR	1125.00
D3348	RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - MOLAR	1275.00
D3351	APEXIFICATION/RECALCIFICATION - INITIAL VISIT (APICAL CLOSURE / CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.)	250.00
D3352	APEXIFICATION/RECALCIFICATION - INTERIM MEDICATION REPLACEMENT	183.04
D3353	APEXIFICATION/RECALCIFICATION - FINAL VISIT (INCLUDES COMPLETED ROOT CANAL THERAPY - APICAL CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.)	563.20
D3355	PULPAL REGENERATION - INITIAL VISIT	408.32
D3356	PULPAL REGENERATION - INTERIM MEDICATION REPLACEMENT	183.04
D3357	PULPAL REGENERATION - COMPLETION OF TREATMENT	BR
D3410	APICOECTOMY - ANTERIOR	835.00
D3421	APICOECTOMY - PREMOLAR (FIRST ROOT)	985.00
D3425	APICOECTOMY - MOLAR (FIRST ROOT)	850.00
D3426	APICOECTOMY (EACH ADDITIONAL ROOT)	344.96
D3427	PERIRADICULAR SURGERY WITHOUT APICOECTOMY	732.16
D3428	BONE GRAFT IN CONJUNCTION WITH PERIRADICULAR SURGERY - PER TOOTH, SINGLE SITE	1067.26
D3429	BONE GRAFT IN CONJUNCTION WITH PERIRADICULAR SURGERY - EACH ADDITIONAL CONTIGUOUS TOOTH IN THE SAME SURGICAL SITE	1017.98
D3430	RETROGRADE FILLING - PER ROOT	228.00
D3431	BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION IN CONJUNCTION WITH PERIRADICULAR SURGERY	1253.12
D3432	GUIDED TISSUE REGENERATION, RESORBABLE BARRIER, PER SITE, IN CONJUNCTION WITH PERIRADICULAR SURGERY	1077.12
D3450	ROOT AMPUTATION - PER ROOT	528.00
D3460	ENDODONTIC ENDOSSEOUS IMPLANT	1971.20
D3470	INTENTIONAL REIMPLANTATION (INCLUDING NECESSARY SPLINTING)	1006.72
D3910	SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM	140.80
D3920	HEMISECTION (INCLUDING ANY ROOT REMOVAL), NOT INCLUDING ROOT CANAL THERAPY	401.28
D3950	CANAL PREPARATION AND FITTING OF PREFORMED DOWEL OR POST	183.04
D3999	UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT	BR
D4210	GINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT	950.00
D4211	GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT	270.00
D4212	GINGIVECTOMY OR GINGIVOPLASTY TO ALLOW ACCESS FOR RESTORATIVE PROCEDURE, PER TOOTH	138.00
D4230	ANATOMICAL CROWN EXPOSURE - FOUR OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT	802.42
D4231	ANATOMICAL CROWN EXPOSURE - ONE TO THREE TEETH OR TOOTH BOUNDED SPACES PER QUADRANT	350.00
D4240	GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT	1200.00
D4241	GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT	597.60
D4245	APICALLY POSITIONED FLAP	534.95
D4249	CLINICAL CROWN LENGTHENING - HARD TISSUE	673.00
D4260	OSSEOUS SURGERY (INCLUDING ELEVATION OF A FULL THICKNESS FLAP AND CLOSURE) - FOUR OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT	1299.00
D4261	OSSEOUS SURGERY (INCLUDING ELEVATION OF A FULL THICKNESS FLAP AND CLOSURE) - ONE TO THREE CONTIGUOUS TEETH OR TOOTH BOUNDED SPACES PER QUADRANT	915.00
D4263	BONE REPLACEMENT GRAFT - RETAINED NATURAL TOOTH - FIRST SITE IN QUADRANT	450.00
D4264	BONE REPLACEMENT GRAFT - RETAINED NATURAL TOOTH - EACH ADDITIONAL SITE IN QUADRANT	506.00
D4265	BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION	375.00
D4266	GUIDED TISSUE REGENERATION - RESORBABLE BARRIER, PER SITE	425.00
D4267	GUIDED TISSUE REGENERATION - NONRESORBABLE BARRIER, PER SITE (INCLUDES MEMBRANE REMOVAL)	350.00
D4268	SURGICAL REVISION PROCEDURE, PER TOOTH	BR
D4270	PEDICLE SOFT TISSUE GRAFT PROCEDURE	440.00
D4273	AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE (INCLUDING DONOR AND RECIPIENT SURGICAL SITES) FIRST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT	1200.00
D4274	MESIAL/DISTAL WEDGE PROCEDURE, SINGLE TOOTH (WHEN NOT PERFORMED IN CONJUNCTION WITH SURGICAL PROCEDURES IN THE SAME ANATOMICAL AREA)	595.00
D4275	NON-AUTOGENOUS CONNECTIVE TISSUE GRAFT (INCLUDING RECIPIENT SITE AND DONOR MATERIAL) FIRST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT	1200.00
D4276	COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT, PER TOOTH	1178.15
D4277	FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING RECIPIENT AND DONOR SURGICAL SITES) FIRST TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN GRAFT	999.00
D4278	FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING RECIPIENT AND DONOR SURGICAL SITES) EACH ADDITIONAL CONTIGUOUS TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN SAME GRAFT SITE	625.00
D4283	AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE (INCLUDING DONOR AND RECIPIENT SURGICAL SITES) -EACH ADDITIONAL CONTIGUOUS TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN SAME GRAFT SITE	806.00
D4285	NON-AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE (INCLUDING RECIPIENT SURGICAL SITE AND DONOR MATERIAL) - EACH ADDITIONAL CONTIGUOUS TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN SAME GRAFT SITE	400.00
D4320	PROVISIONAL SPLINTING - INTRACORONAL	546.00
D4321	PROVISIONAL SPLINTING - EXTRACORONAL	327.00
D4341	PERIODONTAL SCALING AND ROOT PLANING - FOUR OR MORE TEETH PER QUADRANT	245.00
D4342	PERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH PER QUADRANT	178.00
D4346	SCALING IN PRESENCE OF GENERALIZED MODERATE OR SEVERE GINGIVAL INFLAMMATION - FULL MOUTH, AFTER ORAL EVALUATION	150.00
D4355	FULL MOUTH DEBRIDEMENT TO ENABLE A COMPREHENSIVE ORAL EVALUATION AND DIAGNOSIS ON A SUBSEQUENT VISIT	165.00
D4381	LOCALIZED DELIVERY OF ANTIMICROBIAL AGENTS VIA A CONTROLLED RELEASE VEHICLE INTO DISEASED CREVICULAR TISSUE, PER TOOTH	78.00
D4910	PERIODONTAL MAINTENANCE	138.00
D4920	UNSCHEDULED DRESSING CHANGE (BY SOMEONE OTHER THAN TREATING DENTIST OR THEIR STAFF)	108.26
D4921	GINGIVAL IRRIGATION - PER QUADRANT	17.00
D4999	UNSPECIFIED PERIODONTAL PROCEDURE, BY REPORT	BR
D5110	COMPLETE DENTURE - MAXILLARY	1325.00
D5120	COMPLETE DENTURE - MANDIBULAR	1295.00
D5130	IMMEDIATE DENTURE - MAXILLARY	1470.01
D5140	IMMEDIATE DENTURE - MANDIBULAR	1402.00
D5211	MAXILLARY PARTIAL DENTURE - RESIN BASE (INCLUDING, RETENTIVE/CLASPING MATERIALS, RESTS, AND TEETH)	950.00
D5212	MANDIBULAR PARTIAL DENTURE - RESIN BASE (INCLUDING, RETENTIVE/CLASPING MATERIALS, RESTS, AND TEETH)	1095.00
D5213	MAXILLARY PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)	1485.00
D5214	MANDIBULAR PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)	1500.01
D5221	IMMEDIATE MAXILLARY PARTIAL DENTURE - RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)	909.00
D5222	IMMEDIATE MANDIBULAR PARTIAL DENTURE - RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)	909.00
D5223	IMMEDIATE MAXILLARY PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)	1200.00
D5224	IMMEDIATE MANDIBULAR PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)	1300.00
D5225	MAXILLARY PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING ANY CLASPS, RESTS AND TEETH)	1275.00
D5226	MANDIBULAR PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING ANY CLASPS, RESTS AND TEETH)	1400.00
D5282	REMOVABLE UNILATERAL PARTIAL DENTURE - ONE PIECE CAST METAL (INCLUDING CLASPS AND TEETH), MAXILLARY	889.56
D5283	REMOVABLE UNILATERAL PARTIAL DENTURE - ONE PIECE CAST METAL (INCLUDING CLASPS AND TEETH), MANDIBULAR	889.56
D5410	ADJUST COMPLETE DENTURE - MAXILLARY	88.00
D5411	ADJUST COMPLETE DENTURE - MANDIBULAR	88.00
D5421	ADJUST PARTIAL DENTURE - MAXILLARY	80.00
D5422	ADJUST PARTIAL DENTURE - MANDIBULAR	82.00
D5511	REPAIR BROKEN COMPLETE DENTURE BASE, MANDIBULAR	155.00
D5512	REPAIR BROKEN COMPLETE DENTURE BASE, MAXILLARY	155.00
D5520	REPLACE MISSING OR BROKEN TEETH - COMPLETE DENTURE (EACH TOOTH)	155.00
D5611	REPAIR RESIN PARTIAL DENTURE BASE, MANDIBULAR	189.00
D5612	REPAIR RESIN PARTIAL DENTURE BASE, MAXILLARY	160.00
D5621	REPAIR CAST PARTIAL FRAMEWORK, MANDIBULAR	176.40
D5622	REPAIR CAST PARTIAL FRAMEWORK, MAXILLARY	176.40
D5630	REPAIR OR REPLACE BROKEN RETENTIVE CLASPING MATERIALS - PER TOOTH	225.00
D5640	REPLACE BROKEN TEETH - PER TOOTH	167.00
D5650	ADD TOOTH TO EXISTING PARTIAL DENTURE	197.00
D5660	ADD CLASP TO EXISTING PARTIAL DENTURE - PER TOOTH	220.00
D5670	REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MAXILLARY)	554.40
D5671	REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MANDIBULAR)	554.40
D5710	REBASE COMPLETE MAXILLARY DENTURE	550.00
D5711	REBASE COMPLETE MANDIBULAR DENTURE	400.00
D5720	REBASE MAXILLARY PARTIAL DENTURE	529.20
D5721	REBASE MANDIBULAR PARTIAL DENTURE	493.00
D5730	RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)	308.00
D5731	RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)	308.00
D5740	RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE)	295.00
D5741	RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE)	285.00
D5750	RELINE COMPLETE MAXILLARY DENTURE (LABORATORY)	432.00
D5751	RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY)	439.00
D5760	RELINE MAXILLARY PARTIAL DENTURE (LABORATORY)	426.00
D5761	RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY)	386.00
D5810	INTERIM COMPLETE DENTURE (MAXILLARY)	750.00
D5811	INTERIM COMPLETE DENTURE (MANDIBULAR)	718.20
D5820	INTERIM PARTIAL DENTURE (MAXILLARY)	590.00
D5821	INTERIM PARTIAL DENTURE (MANDIBULAR)	550.00
D5850	TISSUE CONDITIONING, MAXILLARY	145.00
D5851	TISSUE CONDITIONING, MANDIBULAR	130.00
D5862	PRECISION ATTACHMENT, BY REPORT	BR
D5863	OVERDENTURE - COMPLETE MAXILLARY	1461.60
D5864	OVERDENTURE - PARTIAL MAXILLARY	1927.80
D5865	OVERDENTURE - COMPLETE MANDIBULAR	1461.60
D5866	OVERDENTURE - PARTIAL MANDIBULAR	2003.40
D5867	REPLACEMENT OF REPLACEABLE PART OF SEMI-PRECISION OR PRECISION ATTACHMENT (MALE OR FEMALE COMPONENT)	175.00
D5875	MODIFICATION OF REMOVABLE PROSTHESIS FOLLOWING IMPLANT SURGERY	BR
D5876	ADD METAL SUBSTRUCTURE TO ACRYLIC FULL DENTURE (PER ARCH)	BR
D5899	UNSPECIFIED REMOVABLE PROSTHODONTIC PROCEDURE, BY REPORT	BR
D5911	FACIAL MOULAGE (SECTIONAL)	258.01
D5912	FACIAL MOULAGE (COMPLETE)	258.01
D5913	NASAL PROSTHESIS	5433.04
D5914	AURICULAR PROSTHESIS	5433.04
D5915	ORBITAL PROSTHESIS	7352.33
D5916	OCULAR PROSTHESIS	1961.05
D5919	FACIAL PROSTHESIS	BR
D5922	NASAL SEPTAL PROSTHESIS	BR
D5923	OCULAR PROSTHESIS, INTERIM	BR
D5924	CRANIAL PROSTHESIS	BR
D5925	FACIAL AUGMENTATION IMPLANT PROSTHESIS	BR
D5926	NASAL PROSTHESIS, REPLACEMENT	BR
D5927	AURICULAR PROSTHESIS, REPLACEMENT	BR
D5928	ORBITAL PROSTHESIS, REPLACEMENT	BR
D5929	FACIAL PROSTHESIS, REPLACEMENT	BR
D5931	OBTURATOR PROSTHESIS, SURGICAL	2925.34
D5932	OBTURATOR PROSTHESIS, DEFINITIVE	5471.09
D5933	OBTURATOR PROSTHESIS, MODIFICATION	BR
D5934	MANDIBULAR RESECTION PROSTHESIS WITH GUIDE FLANGE	4986.63
D5935	MANDIBULAR RESECTION PROSTHESIS WITHOUT GUIDE FLANGE	4338.82
D5936	OBTURATOR PROSTHESIS, INTERIM	4873.40
D5937	TRISMUS APPLIANCE (NOT FOR TMD TREATMENT)	612.54
D5951	FEEDING AID	796.30
D5952	SPEECH AID PROSTHESIS, PEDIATRIC	2585.66
D5953	SPEECH AID PROSTHESIS, ADULT	4910.52
D5954	PALATAL AUGMENTATION PROSTHESIS	4550.43
D5955	PALATAL LIFT PROSTHESIS, DEFINITIVE	4208.89
D5958	PALATAL LIFT PROSTHESIS, INTERIM	BR
D5959	PALATAL LIFT PROSTHESIS, MODIFICATION	BR
D5960	SPEECH AID PROSTHESIS, MODIFICATION	BR
D5982	SURGICAL STENT	413.00
D5983	RADIATION CARRIER	928.09
D5984	RADIATION SHIELD	928.09
D5985	RADIATION CONE LOCATOR	928.09
D5986	FLUORIDE GEL CARRIER	45.00
D5987	COMMISSURE SPLINT	1392.14
D5988	SURGICAL SPLINT	278.43
D5991	VESICULOBULLOUS DISEASE MEDICAMENT CARRIER	106.73
D5992	ADJUST MAXILLOFACIAL PROSTHETIC APPLIANCE, BY REPORT	BR
D5993	MAINTENANCE AND CLEANING OF A MAXILLOFACIAL PROSTHESIS (EXTRA- OR INTRA-ORAL) OTHER THAN REQUIRED ADJUSTMENTS, BY REPORT	BR
D5994	PERIODONTAL MEDICAMENT CARRIER WITH PERIPHERAL SEAL - LABORATORY PROCESSED	700.00
D5999	UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT	BR
D6010	SURGICAL PLACEMENT OF IMPLANT BODY: ENDOSTEAL IMPLANT	1899.99
D6011	SECOND STAGE IMPLANT SURGERY	190.00
D6012	SURGICAL PLACEMENT OF INTERIM IMPLANT BODY FOR TRANSITIONAL PROSTHESIS: ENDOSTEAL IMPLANT	2175.39
D6013	SURGICAL PLACEMENT OF MINI IMPLANT	1200.00
D6040	SURGICAL PLACEMENT: EPOSTEAL IMPLANT	7921.94
D6050	SURGICAL PLACEMENT: TRANSOSTEAL IMPLANT	5910.02
D6051	INTERIM ABUTMENT	80.00
D6052	SEMI-PRECISION ATTACHMENT ABUTMENT	695.00
D6055	CONNECTING BAR - IMPLANT SUPPORTED OR ABUTMENT SUPPORTED	691.60
D6056	PREFABRICATED ABUTMENT - INCLUDES MODIFICATION AND PLACEMENT	555.00
D6057	CUSTOM FABRICATED ABUTMENT - INCLUDES PLACEMENT	750.00
D6058	ABUTMENT SUPPORTED PORCELAIN/CERAMIC CROWN	1280.00
D6059	ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (HIGH NOBLE METAL)	1292.00
D6060	ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (PREDOMINANTLY BASE METAL)	1290.00
D6061	ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (NOBLE METAL)	1281.00
D6062	ABUTMENT SUPPORTED CAST METAL CROWN (HIGH NOBLE METAL)	1013.00
D6063	ABUTMENT SUPPORTED CAST METAL CROWN (PREDOMINANTLY BASE METAL)	1093.98
D6064	ABUTMENT SUPPORTED CAST METAL CROWN (NOBLE METAL)	1223.00
D6065	IMPLANT SUPPORTED PORCELAIN/CERAMIC CROWN	1400.00
D6066	IMPLANT SUPPORTED PORCELAIN FUSED TO METAL CROWN (TITANIUM, TITANIUM ALLOY, HIGH NOBLE METAL)	1450.00
D6067	IMPLANT SUPPORTED METAL CROWN (TITANIUM, TITANIUM ALLOY, HIGH NOBLE METAL)	1232.30
D6068	ABUTMENT SUPPORTED RETAINER FOR PORCELAIN/CERAMIC FPD	1307.00
D6069	ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (HIGH NOBLE METAL)	962.00
D6070	ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (PREDOMINANTLY BASE METAL)	1236.07
D6071	ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (NOBLE METAL)	1550.00
D6072	ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (HIGH NOBLE METAL)	1276.31
D6073	ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (PREDOMINANTLY BASE METAL)	1165.66
D6074	ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (NOBLE METAL)	1238.59
D6075	IMPLANT SUPPORTED RETAINER FOR CERAMIC FPD	1329.00
D6076	IMPLANT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (TITANIUM, TITANIUM ALLOY, OR HIGH NOBLE METAL)	1800.00
D6077	IMPLANT SUPPORTED RETAINER FOR CAST METAL FPD (TITANIUM, TITANIUM ALLOY, OR HIGH NOBLE METAL)	1232.30
D6080	IMPLANT MAINTENANCE PROCEDURES WHEN PROSTHESES ARE REMOVED AND REINSERTED, INCLUDING CLEANSING OF PROSTHESES AND ABUTMENTS	158.00
D6081	SCALING AND DEBRIDEMENT IN THE PRESENCE OF INFLAMMATION OR MUCOSITIS OF A SINGLE IMPLANT, INCLUDING CLEANING OF THE IMPLANT SURFACES, WITHOUT FLAP ENTRY AND CLOSURE	55.33
D6085	PROVISIONAL IMPLANT CROWN	379.75
D6090	REPAIR IMPLANT SUPPORTED PROSTHESIS, BY REPORT	BR
D6091	REPLACEMENT OF SEMI-PRECISION OR PRECISION ATTACHMENT (MALE OR FEMALE COMPONENT) OF IMPLANT/ABUTMENT SUPPORTED PROSTHESIS, PER ATTACHMENT	95.00
D6092	RE-CEMENT OR RE-BOND IMPLANT/ABUTMENT SUPPORTED CROWN	137.00
D6093	RE-CEMENT OR RE-BOND IMPLANT/ABUTMENT SUPPORTED FIXED PARTIAL DENTURE	159.70
D6094	ABUTMENT SUPPORTED CROWN - (TITANIUM)	1037.40
D6095	REPAIR IMPLANT ABUTMENT, BY REPORT	BR
D6096	REMOVE BROKEN IMPLANT RETAINING SCREW	BR
D6100	IMPLANT REMOVAL, BY REPORT	BR
D6101	DEBRIDEMENT OF A PERI-IMPLANT DEFECT OR DEFECTS SURROUNDING A SINGLE IMPLANT, AND SURFACE CLEANING OF THE EXPOSED IMPLANT SURFACES, INCLUDING FLAP ENTRY AND CLOSURE	373.46
D6102	DEBRIDEMENT AND OSSEOUS CONTOURING OF A PERI-IMPLANT DEFECT OR DEFECTS SURROUNDING A SINGLE IMPLANT AND INCLUDES SURFACE CLEANING OF THE EXPOSED IMPLANT SURFACES, INCLUDING FLAP ENTRY AND CLOSURE	513.04
D6103	BONE GRAFT FOR REPAIR OF PERI-IMPLANT DEFECT - DOES NOT INCLUDE FLAP ENTRY AND CLOSURE	427.53
D6104	BONE GRAFT AT TIME OF IMPLANT PLACEMENT	400.00
D6110	IMPLANT /ABUTMENT SUPPORTED REMOVABLE DENTURE FOR EDENTULOUS ARCH - MAXILLARY	2993.01
D6111	IMPLANT /ABUTMENT SUPPORTED REMOVABLE DENTURE FOR EDENTULOUS ARCH - MANDIBULAR	3000.00
D6112	IMPLANT /ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH - MAXILLARY	1718.93
D6113	IMPLANT /ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH - MANDIBULAR	1718.93
D6114	IMPLANT /ABUTMENT SUPPORTED FIXED DENTURE FOR EDENTULOUS ARCH - MAXILLARY	3010.34
D6115	IMPLANT /ABUTMENT SUPPORTED FIXED DENTURE FOR EDENTULOUS ARCH - MANDIBULAR	3010.34
D6116	IMPLANT /ABUTMENT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENTULOUS ARCH - MAXILLARY	2308.68
D6117	IMPLANT /ABUTMENT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENTULOUS ARCH - MANDIBULAR	2308.68
D6118	IMPLANT/ABUTMENT SUPPORTED INTERIM FIXED DENTURE FOR EDENTULOUS ARCH - MANDIBULAR	1565.53
D6119	IMPLANT/ABUTMENT SUPPORTED INTERIM FIXED DENTURE FOR EDENTULOUS ARCH - MAXILLARY	1565.53
D6190	RADIOGRAPHIC/SURGICAL IMPLANT INDEX, BY REPORT	BR
D6194	ABUTMENT SUPPORTED RETAINER CROWN FOR FPD (TITANIUM)	1068.83
D6199	UNSPECIFIED IMPLANT PROCEDURE, BY REPORT	BR
D6205	PONTIC - INDIRECT RESIN BASED COMPOSITE	638.77
D6210	PONTIC - CAST HIGH NOBLE METAL	1090.00
D6211	PONTIC - CAST PREDOMINANTLY BASE METAL	915.16
D6212	PONTIC - CAST NOBLE METAL	952.01
D6214	PONTIC - TITANIUM	982.72
D6240	PONTIC - PORCELAIN FUSED TO HIGH NOBLE METAL	994.00
D6241	PONTIC - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL	924.00
D6242	PONTIC - PORCELAIN FUSED TO NOBLE METAL	1000.00
D6245	PONTIC - PORCELAIN/CERAMIC	1090.00
D6250	PONTIC - RESIN WITH HIGH NOBLE METAL	952.01
D6251	PONTIC - RESIN WITH PREDOMINANTLY BASE METAL	925.00
D6252	PONTIC - RESIN WITH NOBLE METAL	950.00
D6253	PROVISIONAL PONTIC - FURTHER TREATMENT OR COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO FINAL IMPRESSION	410.29
D6545	RETAINER - CAST METAL FOR RESIN BONDED FIXED PROSTHESIS	732.00
D6548	RETAINER - PORCELAIN/CERAMIC FOR RESIN BONDED FIXED PROSTHESIS	990.00
D6549	RETAINER - FOR RESIN BONDED FIXED PROSTHESIS	292.36
D6600	RETAINER INLAY - PORCELAIN/CERAMIC, TWO SURFACES	804.60
D6601	RETAINER INLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES	843.91
D6602	RETAINER INLAY - CAST HIGH NOBLE METAL, TWO SURFACES	859.88
D6603	RETAINER INLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES	945.87
D6604	RETAINER INLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES	842.68
D6605	RETAINER INLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES	893.05
D6606	RETAINER INLAY - CAST NOBLE METAL, TWO SURFACES	829.17
D6607	RETAINER INLAY - CAST NOBLE METAL, THREE OR MORE SURFACES	920.07
D6608	RETAINER ONLAY - PORCELAIN/CERAMIC, TWO SURFACES	874.62
D6609	RETAINER ONLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES	912.70
D6610	RETAINER ONLAY - CAST HIGH NOBLE METAL, TWO SURFACES	927.44
D6611	RETAINER ONLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES	1014.66
D6612	RETAINER ONLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES	922.53
D6613	RETAINER ONLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES	964.29
D6614	RETAINER ONLAY - CAST NOBLE METAL, TWO SURFACES	902.87
D6615	RETAINER ONLAY - CAST NOBLE METAL, THREE OR MORE SURFACES	938.50
D6624	RETAINER INLAY - TITANIUM	859.88
D6634	RETAINER ONLAY - TITANIUM	902.87
D6710	RETAINER CROWN - INDIRECT RESIN BASED COMPOSITE	115.00
D6720	RETAINER CROWN - RESIN WITH HIGH NOBLE METAL	956.00
D6721	RETAINER CROWN - RESIN WITH PREDOMINANTLY BASE METAL	1019.57
D6722	RETAINER CROWN - RESIN WITH NOBLE METAL	1302.00
D6740	RETAINER CROWN - PORCELAIN/CERAMIC	1088.00
D6750	RETAINER CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL	998.00
D6751	RETAINER CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL	945.00
D6752	RETAINER CROWN - PORCELAIN FUSED TO NOBLE METAL	1000.00
D6780	RETAINER CROWN - 3/4 CAST HIGH NOBLE METAL	1038.00
D6781	RETAINER CROWN - 3/4 CAST PREDOMINANTLY BASE METAL	1038.00
D6782	RETAINER CROWN - 3/4 CAST NOBLE METAL	964.29
D6783	RETAINER CROWN - 3/4 PORCELAIN/CERAMIC	1068.71
D6790	RETAINER CROWN - FULL CAST HIGH NOBLE METAL	1300.00
D6791	RETAINER CROWN - FULL CAST PREDOMINANTLY BASE METAL	1007.29
D6792	RETAINER CROWN - FULL CAST NOBLE METAL	1044.14
D6793	PROVISIONAL RETAINER CROWN - FURTHER TREATMENT OR COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO FINAL IMPRESSION	478.00
D6794	RETAINER CROWN - TITANIUM	1044.14
D6920	CONNECTOR BAR	221.11
D6930	RE-CEMENT OR RE-BOND FIXED PARTIAL DENTURE	141.00
D6940	STRESS BREAKER	292.36
D6950	PRECISION ATTACHMENT	559.00
D6980	FIXED PARTIAL DENTURE REPAIR NECESSITATED BY RESTORATIVE MATERIAL FAILURE	249.00
D6985	PEDIATRIC PARTIAL DENTURE, FIXED	491.36
D6999	UNSPECIFIED FIXED PROSTHODONTIC PROCEDURE, BY REPORT	BR
D7111	EXTRACTION, CORONAL REMNANTS - PRIMARY TOOTH	111.00
D7140	EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL)	160.00
D7210	EXTRACTION, ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF TOOTH, AND INCLUDING ELEVATION OF MUCOPERIOSTEAL FLAP IF INDICATED	250.00
D7220	REMOVAL OF IMPACTED TOOTH - SOFT TISSUE	315.00
D7230	REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY	400.00
D7240	REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY	460.00
D7241	REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY, WITH UNUSUAL SURGICAL COMPLICATIONS	500.00
D7250	REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)	255.00
D7251	CORONECTOMY - INTENTIONAL PARTIAL TOOTH REMOVAL	450.00
D7260	OROANTRAL FISTULA CLOSURE	1618.34
D7261	PRIMARY CLOSURE OF A SINUS PERFORATION	674.31
D7270	TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED TOOTH	498.00
D7272	TOOTH TRANSPLANTATION (INCLUDES REIMPLANTATION FROM ONE SITE TO ANOTHER AND SPLINTING AND/OR STABILIZATION)	674.31
D7280	EXPOSURE OF AN UNERUPTED TOOTH	555.00
D7282	MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION	200.00
D7283	PLACEMENT OF DEVICE TO FACILITATE ERUPTION OF IMPACTED TOOTH	255.00
D7285	INCISIONAL BIOPSY OF ORAL TISSUE-HARD (BONE, TOOTH)	900.00
D7286	INCISIONAL BIOPSY OF ORAL TISSUE-SOFT	399.00
D7287	EXFOLIATIVE CYTOLOGICAL SAMPLE COLLECTION	161.83
D7288	BRUSH BIOPSY - TRANSEPITHELIAL SAMPLE COLLECTION	161.83
D7290	SURGICAL REPOSITIONING OF TEETH	404.59
D7291	TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, BY REPORT	BR
D7292	PLACEMENT OF TEMPORARY ANCHORAGE DEVICE [SCREW RETAINED PLATE] REQUIRING FLAP; INCLUDES DEVICE REMOVAL	647.34
D7293	PLACEMENT OF TEMPORARY ANCHORAGE DEVICE REQUIRING FLAP; INCLUDES DEVICE REMOVAL	404.59
D7294	PLACEMENT OF TEMPORARY ANCHORAGE DEVICE WITHOUT FLAP; INCLUDES DEVICE REMOVAL	337.16
D7295	HARVEST OF BONE FOR USE IN AUTOGENOUS GRAFTING PROCEDURE	BR
D7296	CORTICOTOMY - ONE TO THREE TEETH OR TOOTH SPACES, PER QUADRANT	BR
D7297	CORTICOTOMY - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT	BR
D7310	ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT	220.00
D7311	ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH SPACES, PER QUADRANT	175.00
D7320	ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPACES, PER QUADRANT	368.00
D7321	ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH SPACES, PER QUADRANT	327.00
D7340	VESTIBULOPLASTY - RIDGE EXTENSION (SECONDARY EPITHELIALIZATION)	1854.35
D7350	VESTIBULOPLASTY - RIDGE EXTENSION (INCLUDING SOFT TISSUE GRAFTS, MUSCLE REATTACHMENT, REVISION OF SOFT TISSUE ATTACHMENT AND MANAGEMENT OF HYPERTROPHIED AND HYPERPLASTIC TISSUE)	5394.48
D7410	EXCISION OF BENIGN LESION UP TO 1.25 CM	425.00
D7411	EXCISION OF BENIGN LESION GREATER THAN 1.25 CM	650.00
D7412	EXCISION OF BENIGN LESION, COMPLICATED	1416.05
D7413	EXCISION OF MALIGNANT LESION UP TO 1.25 CM	944.03
D7414	EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM	1416.05
D7415	EXCISION OF MALIGNANT LESION, COMPLICATED	1584.63
D7440	EXCISION OF MALIGNANT TUMOR - LESION DIAMETER UP TO 1.25 CM	1281.19
D7441	EXCISION OF MALIGNANT TUMOR - LESION DIAMETER GREATER THAN 1.25 CM	1888.07
D7450	REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM	990.00
D7451	REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN 1.25 CM	975.00
D7460	REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM	809.17
D7461	REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN 1.25 CM	1105.87
D7465	DESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL METHOD, BY REPORT	BR
D7471	REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE)	650.00
D7472	REMOVAL OF TORUS PALATINUS	1190.83
D7473	REMOVAL OF TORUS MANDIBULARIS	695.00
D7485	REDUCTION OF OSSEOUS TUBEROSITY	425.00
D7490	RADICAL RESECTION OF MAXILLA OR MANDIBLE	8091.72
D7510	INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE	220.00
D7511	INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE - COMPLICATED (INCLUDES DRAINAGE OF MULTIPLE FASCIAL SPACES)	295.00
D7520	INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE	1380.99
D7521	INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE - COMPLICATED (INCLUDES DRAINAGE OF MULTIPLE FASCIAL SPACES)	1517.20
D7530	REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE	497.64
D7540	REMOVAL OF REACTION PRODUCING FOREIGN BODIES, MUSCULOSKELETAL SYSTEM	551.59
D7550	PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE	950.00
D7560	MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT OR FOREIGN BODY	2730.96
D7610	MAXILLA - OPEN REDUCTION (TEETH IMMOBILIZED, IF PRESENT)	4416.73
D7620	MAXILLA - CLOSED REDUCTION (TEETH IMMOBILIZED, IF PRESENT)	3312.21
D7630	MANDIBLE - OPEN REDUCTION (TEETH IMMOBILIZED, IF PRESENT)	5742.42
D7640	MANDIBLE - CLOSED REDUCTION (TEETH IMMOBILIZED, IF PRESENT)	3643.97
D7650	MALAR AND/OR ZYGOMATIC ARCH - OPEN REDUCTION	2760.63
D7660	MALAR AND/OR ZYGOMATIC ARCH - CLOSED REDUCTION	1627.78
D7670	ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH	1270.40
D7671	ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH	2393.80
D7680	FACIAL BONES - COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL APPROACHES	8281.88
D7710	MAXILLA - OPEN REDUCTION	5190.84
D7720	MAXILLA - CLOSED REDUCTION	3643.97
D7730	MANDIBLE - OPEN REDUCTION	7509.12
D7740	MANDIBLE - CLOSED REDUCTION	3715.45
D7750	MALAR AND/OR ZYGOMATIC ARCH - OPEN REDUCTION	4725.56
D7760	MALAR AND/OR ZYGOMATIC ARCH - CLOSED REDUCTION	1896.16
D7770	ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH	2569.12
D7771	ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH	1982.47
D7780	FACIAL BONES - COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE APPROACHES	11042.50
D7810	OPEN REDUCTION OF DISLOCATION	4857.73
D7820	CLOSED REDUCTION OF DISLOCATION	795.69
D7830	MANIPULATION UNDER ANESTHESIA	455.83
D7840	CONDYLECTOMY	6621.72
D7850	SURGICAL DISCECTOMY, WITH/WITHOUT IMPLANT	5718.15
D7852	DISC REPAIR	6547.55
D7854	SYNOVECTOMY	6756.59
D7856	MYOTOMY	4794.34
D7858	JOINT RECONSTRUCTION	13665.57
D7860	ARTHROTOMY	5824.69
D7865	ARTHROPLASTY	9386.40
D7870	ARTHROCENTESIS	310.18
D7871	NON-ARTHROSCOPIC LYSIS AND LAVAGE	620.37
D7872	ARTHROSCOPY - DIAGNOSIS, WITH OR WITHOUT BIOPSY	3310.86
D7873	ARTHROSCOPY: LAVAGE AND LYSIS OF ADHESIONS	3986.52
D7874	ARTHROSCOPY: DISC REPOSITIONING AND STABILIZATION	5718.15
D7875	ARTHROSCOPY: SYNOVECTOMY	6264.34
D7876	ARTHROSCOPY: DISCECTOMY	6753.89
D7877	ARTHROSCOPY: DEBRIDEMENT	5960.90
D7880	OCCLUSAL ORTHOTIC DEVICE, BY REPORT	BR
D7881	OCCLUSAL ORTHOTIC DEVICE ADJUSTMENT	80.92
D7899	UNSPECIFIED TMD THERAPY, BY REPORT	BR
D7910	SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM	80.00
D7911	COMPLICATED SUTURE - UP TO 5 CM	1104.52
D7912	COMPLICATED SUTURE - GREATER THAN 5 CM	1987.87
D7920	SKIN GRAFT (IDENTIFY DEFECT COVERED, LOCATION AND TYPE OF GRAFT)	3256.92
D7921	COLLECTION AND APPLICATION OF AUTOLOGOUS BLOOD CONCENTRATE PRODUCT	299.00
D7940	OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES	BR
D7941	OSTEOTOMY - MANDIBULAR RAMI	8294.01
D7943	OSTEOTOMY - MANDIBULAR RAMI WITH BONE GRAFT; INCLUDES OBTAINING THE GRAFT	7619.70
D7944	OSTEOTOMY - SEGMENTED OR SUBAPICAL	6790.30
D7945	OSTEOTOMY - BODY OF MANDIBLE	9035.75
D7946	LEFORT I (MAXILLA - TOTAL)	11193.55
D7947	LEFORT I (MAXILLA - SEGMENTED)	9413.37
D7948	LEFORT II OR LEFORT III (OSTEOPLASTY OF FACIAL BONES FOR MIDFACE HYPOPLASIA OR RETRUSION) - WITHOUT BONE GRAFT	12218.50
D7949	LEFORT II OR LEFORT III - WITH BONE GRAFT	15913.72
D7950	OSSEOUS, OSTEOPERIOSTEAL, OR CARTILAGE GRAFT OF THE MANDIBLE OR MAXILLA - AUTOGENOUS OR NONAUTOGENOUS, BY REPORT	BR
D7951	SINUS AUGMENTATION WITH BONE OR BONE SUBSTITUTES VIA A LATERAL OPEN APPROACH	1600.00
D7952	SINUS AUGMENTATION VIA A VERTICAL APPROACH	850.00
D7953	BONE REPLACEMENT GRAFT FOR RIDGE PRESERVATION - PER SITE	400.00
D7955	REPAIR OF MAXILLOFACIAL SOFT AND/OR HARD TISSUE DEFECT	BR
D7960	FRENULECTOMY - ALSO KNOWN AS FRENECTOMY OR FRENOTOMY - SEPARATE PROCEDURE NOT INCIDENTAL TO ANOTHER PROCEDURE	450.00
D7963	FRENULOPLASTY	606.88
D7970	EXCISION OF HYPERPLASTIC TISSUE - PER ARCH	197.00
D7971	EXCISION OF PERICORONAL GINGIVA	226.00
D7972	SURGICAL REDUCTION OF FIBROUS TUBEROSITY	305.00
D7979	NON - SURGICAL SIALOLITHOTOMY	BR
D7980	SURGICAL SIALOLITHOTOMY	332.00
D7981	EXCISION OF SALIVARY GLAND, BY REPORT	BR
D7982	SIALODOCHOPLASTY	2009.44
D7983	CLOSURE OF SALIVARY FISTULA	1928.53
D7990	EMERGENCY TRACHEOTOMY	1658.80
D7991	CORONOIDECTOMY	4045.86
D7995	SYNTHETIC GRAFT - MANDIBLE OR FACIAL BONES, BY REPORT	BR
D7996	IMPLANT-MANDIBLE FOR AUGMENTATION PURPOSES (EXCLUDING ALVEOLAR RIDGE), BY REPORT	BR
D7997	APPLIANCE REMOVAL (NOT BY DENTIST WHO PLACED APPLIANCE), INCLUDES REMOVAL OF ARCHBAR	310.18
D7998	INTRAORAL PLACEMENT OF A FIXATION DEVICE NOT IN CONJUNCTION WITH A FRACTURE	1348.62
D7999	UNSPECIFIED ORAL SURGERY PROCEDURE, BY REPORT	BR
D8010	LIMITED ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION	BR
D8020	LIMITED ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION	174.20
D8030	LIMITED ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION	230.00
D8040	LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION	437.50
D8050	INTERCEPTIVE ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION	136.00
D8060	INTERCEPTIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION	240.00
D8070	COMPREHENSIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION	206.00
D8080	COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION	237.00
D8090	COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION	245.00
D8210	REMOVABLE APPLIANCE THERAPY	330.00
D8220	FIXED APPLIANCE THERAPY	807.00
D8660	PRE-ORTHODONTIC TREATMENT EXAMINATION TO MONITOR GROWTH AND DEVELOPMENT	210.00
D8670	PERIODIC ORTHODONTIC TREATMENT VISIT	200.00
D8680	ORTHODONTIC RETENTION (REMOVAL OF APPLIANCES, CONSTRUCTION AND PLACEMENT OF RETAINER(S))	340.00
D8681	REMOVABLE ORTHODONTIC RETAINER ADJUSTMENT	100.00
D8690	ORTHODONTIC TREATMENT (ALTERNATIVE BILLING TO A CONTRACT FEE)	265.00
D8691	REPAIR OF ORTHODONTIC APPLIANCE	104.00
D8692	REPLACEMENT OF LOST OR BROKEN RETAINER	263.00
D8693	RE-CEMENT OR RE-BOND FIXED RETAINER	100.00
D8694	REPAIR OF FIXED RETAINERS, INCLUDES REATTACHMENT	BR
D8695	REMOVAL OF FIXED ORTHODONTIC APPLIANCES FOR REASONS OTHER THAN COMPLETION OF TREATMENT	BR
D8999	UNSPECIFIED ORTHODONTIC PROCEDURE, BY REPORT	BR
D9110	PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN - MINOR PROCEDURE	105.00
D9120	FIXED PARTIAL DENTURE SECTIONING	200.00
D9130	TEMPOROMANDIBULAR JOINT DYSFUNCTION - NON-INVASIVE PHYSICAL THERAPIES	BR
D9210	LOCAL ANESTHESIA NOT IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES	75.00
D9211	REGIONAL BLOCK ANESTHESIA	42.35
D9212	TRIGEMINAL DIVISION BLOCK ANESTHESIA	73.00
D9215	LOCAL ANESTHESIA IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES	56.00
D9219	EVALUATION FOR MODERATE SEDATION, DEEP SEDATION OR GENERAL ANESTHESIA	75.44
D9222	DEEP SEDATION/GENERAL ANESTHESIA - FIRST 15 MINUTES	210.00
D9223	DEEP SEDATION/GENERAL ANESTHESIA - EACH SUBSEQUENT 15 MINUTE INCREMENT	200.00
D9230	INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS	50.00
D9239	INTRAVENOUS MODERATE (CONSCIOUS) SEDATION/ANALGESIA- FIRST 15 MINUTES	170.00
D9243	INTRAVENOUS MODERATE (CONSCIOUS) SEDATION/ANALGESIA - EACH SUBSEQUENT 15 MINUTE INCREMENT	170.00
D9248	NON-INTRAVENOUS CONSCIOUS SEDATION	195.00
D9310	CONSULTATION - DIAGNOSTIC SERVICE PROVIDED BY DENTIST OR PHYSICIAN OTHER THAN REQUESTING DENTIST OR PHYSICIAN	112.00
D9311	CONSULTATION WITH A MEDICAL HEALTH CARE PROFESSIONAL	211.76
D9410	HOUSE/EXTENDED CARE FACILITY CALL	242.21
D9420	HOSPITAL OR AMBULATORY SURGICAL CENTER CALL	295.00
D9430	OFFICE VISIT FOR OBSERVATION (DURING REGULARLY SCHEDULED HOURS) - NO OTHER SERVICES PERFORMED	75.00
D9440	OFFICE VISIT - AFTER REGULARLY SCHEDULED HOURS	155.00
D9450	CASE PRESENTATION, DETAILED AND EXTENSIVE TREATMENT PLANNING	45.00
D9610	THERAPEUTIC PARENTERAL DRUG, SINGLE ADMINISTRATION	30.00
D9612	THERAPEUTIC PARENTERAL DRUGS, TWO OR MORE ADMINISTRATIONS, DIFFERENT MEDICATIONS	180.00
D9613	INFILTRATION OF SUSTAINED RELEASE THERAPEUTIC DRUG - SINGLE OR MULTIPLE SITES	38.38
D9630	DRUGS OR MEDICAMENTS DISPENSED IN THE OFFICE FOR HOME USE	28.00
D9910	APPLICATION OF DESENSITIZING MEDICAMENT	52.00
D9911	APPLICATION OF DESENSITIZING RESIN FOR CERVICAL AND/OR ROOT SURFACE, PER TOOTH	25.00
D9920	BEHAVIOR MANAGEMENT, BY REPORT	BR
D9930	TREATMENT OF COMPLICATIONS (POST-SURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT	BR
D9932	CLEANING AND INSPECTION OF REMOVABLE COMPLETE DENTURE, MAXILLARY	113.82
D9933	CLEANING AND INSPECTION OF REMOVABLE COMPLETE DENTURE, MANDIBULAR	113.82
D9934	CLEANING AND INSPECTION OF REMOVABLE PARTIAL DENTURE, MAXILLARY	113.82
D9935	CLEANING AND INSPECTION OF REMOVABLE PARTIAL DENTURE, MANDIBULAR	113.82
D9941	FABRICATION OF ATHLETIC MOUTHGUARD	145.00
D9942	REPAIR AND/OR RELINE OF OCCLUSAL GUARD	79.00
D9943	OCCLUSAL GUARD ADJUSTMENT	79.41
D9944	OCCLUSAL GUARD - HARD APPLIANCE, FULL ARCH	383.82
D9945	OCCLUSAL GUARD - SOFT APPLIANCE, FULL ARCH	383.82
D9946	OCCLUSAL GUARD - HARD APPLIANCE, PARTIAL ARCH	383.82
D9950	OCCLUSION ANALYSIS - MOUNTED CASE	350.00
D9951	OCCLUSAL ADJUSTMENT - LIMITED	135.00
D9952	OCCLUSAL ADJUSTMENT - COMPLETE	803.00
D9961	DUPLICATE/COPY PATIENT'S RECORDS	BR
D9970	ENAMEL MICROABRASION	156.00
D9971	ODONTOPLASTY 1 - 2 TEETH; INCLUDES REMOVAL OF ENAMEL PROJECTIONS	115.00
D9972	EXTERNAL BLEACHING - PER ARCH - PERFORMED IN OFFICE	220.00
D9973	EXTERNAL BLEACHING - PER TOOTH	50.00
D9974	INTERNAL BLEACHING - PER TOOTH	273.00
D9975	EXTERNAL BLEACHING FOR HOME APPLICATION, PER ARCH; INCLUDES MATERIALS AND FABRICATION OF CUSTOM TRAYS	90.00
D9985	SALES TAX	BR
D9986	MISSED APPOINTMENT	BR
D9987	CANCELLED APPOINTMENT	BR
D9990	CERTIFIED TRANSLATION OR SIGN-LANGUAGE SERVICES - PER VISIT	BR
D9991	DENTAL CASE MANAGEMENT - ADDRESSING APPOINTMENT COMPLIANCE BARRIERS	46.32
D9992	DENTAL CASE MANAGEMENT - CARE COORDINATION	46.32
D9993	DENTAL CASE MANAGEMENT - MOTIVATIONAL INTERVIEWING	46.32
D9994	DENTAL CASE MANAGEMENT - PATIENT EDUCATION TO IMPROVE ORAL HEALTH LITERACY	63.53
D9995	TELEDENTISTRY - SYNCHRONOUS; REAL-TIME ENCOUNTER	211.76
D9996	TELEDENTISTRY - ASYNCHRONOUS; INFORMATION STORED AND FORWARDED TO DENTIST FOR SUBSEQUENT REVIEW	215.00
D9999	UNSPECIFIED ADJUNCTIVE PROCEDURE, BY REPORT	BR

20 Miss. Code. R. § 2-II

Adopted 6/15/2019.