N.J. Admin. Code § 10:56-3.3

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:56-3.3 - D1000-D1999 PREVENTIVE

(a) Dental prophylaxis:

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NOTE: Patients 16 years of age or older, maxillary and mandibular arches; includes additional scaling.

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NOTE 1: Patients 16 years of age or older, maxillary or mandibular arch, includes additional scaling.

NOTE 2: Code to be used if patient is edentulous in one arch.

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NOTE: Patients up to and including 15 years of age, maxillary and mandibular arches; includes additional scaling, includes additional scaling.

1. The following codes should be used when a beneficiary is developmentally disabled or neurologically impaired. (See N.J.A.C. 10:56-2.9(a)1 ii.)

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NOTE: Patients 16 years of age or older, maxillary and mandibular arches.

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NOTE: Patients up to and including 15 years of age, maxillary and mandibular arches.

(b) Topical fluoride treatment (office procedure):

1. Topical application of stannous fluoride or acid fluoride phosphate-one treatment following a complete prophylaxis (fee includes both services).

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NOTE: Patients up to and including 15 years of age, maxillary and mandibular arches.

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NOTE: Patients up to and including 15 years of age, maxillary and mandibular arches.

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NOTE: Patients age 16 up to and including 20 years of age, maxillary and mandibular arches.

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NOTE: Patients age 16 up to and including 20 years of age, maxillary and mandibular arches.

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NOTE: Patients age 16 up to and including 20 years of age, maxillary or mandibular arch. Code to be used if patient is edentulous in one arch.

2. The following codes should be used when a beneficiary is developmentally disabled or neurologically impaired (see N.J.A.C. 10:56-2.9(a)1 ii) when the topical application of fluoride in conjunction with a complete prophylaxis (code includes both services) is necessary.

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NOTE: Patients up to and including 15 years of age, maxillary and mandibular arches.

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NOTE: Patients age 16 up to and including 20 years of age, maxillary and mandibular arches.

(c) Other Preventive Services

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NOTE 1: Unfilled premolars and permanent molars.

NOTE 2: Beneficiaries up to and including 16 years of age.

(d) Space Maintenance (passive appliances)

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NOTE: Utilizing band(s) or stainless steel crowning.

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NOTE: Lingual or palatal arch utilizing bands or stainless steel crowning.

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NOTE: The complete description of procedure(s) and the reason(s) the procedure was performed must be included in the report.

N.J. Admin. Code § 10:56-3.3

Amended by R.1990 d.456, effective 9/4/1990.
See: 22 N.J.R. 1660(b), 22 N.J.R. 2713(a).
In (a)2: added text regarding recipients up to and including 17 years of age. Deleting text regarding patients 16 years of age or older and increasing "Additional Scaling" fees. In "01202 52" changed "and" to "or" regarding mandibular arch.
In (c): Revised text in Note 1 and added new Note 2, recodifying Notes 2-3 as 3-4.
Amended by R.1996 d.428, effective 9/16/1996.
See: 28 N.J.R. 3069(a), 28 N.J.R. 4243(a).
Amended by R.2000 d.426, effective 10/16/2000.
See: 32 N.J.R. 2411(a), 32 N.J.R. 3836(a).
Rewrote the section.
Amended by R.2001 d.268, effective 8/6/2001.
See: 33 N.J.R. 1554(a), 33 N.J.R. 2666(b).
In (a)1, substituted "beneficiary" for "recipient" and increased the Maximum Fee Allowances for Adult and Child Prophylaxis; in (b)2, substituted "beneficiary" for "recipient".
Amended by R.2003 d.16, effective 1/6/2002.
See: 34 N.J.R. 2681(a), 35 N.J.R. 232(a).
Rewrote the section.