N.J. Admin. Code § 10:56-3.4

Current through Register Vol. 56, No. 12, June 17, 2024

Section 10:56-3.4 - D2000-D2999 RESTORATIVE

(a) Amalgam restorations (including polishing):

				Maximum Fee
HCPCS	Allowance
IND	Code	Mod	Procedure Description	S	$	NS
D2110	Amalgam--One Surface, Primary	32.00	30.00
D2120	Amalgam--Two Surfaces, Primary	38.00	35.50
D2130	Amalgam--Three Surfaces, Primary	44.00	41.00
D2131	Amalgam--Four or More Surfaces,	51.00	46.50
Primary
D2140	Amalgam--One Surface, Permanent	32.00	30.00
D2150	Amalgam--Two Surfaces, Permanent	38.00	35.50
D2160	Amalgam--Three Surfaces, Permanent	44.00	41.00
D2161	Amalgam--Four or More Surfaces,	51.00	46.50
Permanent

(b) Filled or Unfilled Resin Restorations:

1. Proximal restorations in anterior teeth are normally considered to be single surface restorations. When access to a proximal cavity is gained by involvement of a second surface, reimbursement will be permitted for only one surface. A two or three surface proximal restoration will be reimbursed only when the facial and/or lingual margin(s) of the restoration extends beyond the proximal one-third of the facial and/or lingual surface(s).

2. Reimbursement will include acid etch where appropriate.

D2330	Resin-based composite--One	35.50	33.00
Surface, anterior
D2331	Resin-based composite--Two	42.50	39.00
Surfaces, anterior
D2332	Resin-based composite--Three	49.50	45.00
Surfaces, anterior
D2335	Resin-based composite--Four or	59.50	54.00
more Surfaces or involving incisal
angle (anterior)
D2336	Resin-based composite crown,	40.00	35.00
anterior--primary
D2337	Resin-based composite crown,	40.00	35.00
anterior--permanent
D2380	Resin-based composite--One	32.00	30.00
surface, posterior--primary
D2381	Resin-based--Two surfaces,	38.00	35.00
posterior--primary
D2382	Resin-based composite--three or	44.00	41.00
more surfaces, posterior--primary

For permanent teeth only:

D2385	Resin-based composite--One	32.00	30.00
surface, posterior--permanent
D2386	Resin-based composite--two	38.00	35.50
surfaces, posterior--permanent
D2387	Resin-based composite--three	44.00	41.00
surfaces, posterior--permanent
D2388	Resin-based composite--four or	44.00	41.00
more surfaces, posterior--permanent

NOTE: Code to be used for three or more surfaces.

(c) Gold Foil Restorations:

1. Primarily for use in Dental Colleges.

D2410	Gold Foil--One Surface	9.00	8.00
D2420	Gold Foil--Two Surfaces	18.00	16.00
D2430	Gold Foil--Three Surfaces	27.00	24.00

NOTE: Code to be used for three or more surfaces.

(d) Inlay Restorations:

1. Primarily for use in dental colleges.

D2510	Inlay--Metallic--One Surface	31.00	27.00
D2520	Inlay--Metallic--Two Surfaces	56.00	49.00
D2530	Inlay--Metallic--Three or more	75.00	65.00
Surfaces

NOTE: Code to be used for three or more surfaces.

D2542	Onlay--Metallic--Two Surfaces	79.00	69.00
D2543	Onlay--Metallic--Three Surfaces	98.00	85.00

(e) Crowns--single restoration only:

1. There is only one fee for each type of crown Use the type of alloy most appropriate for the patient's needs.

2. The Noble Metal Classification System has been adopted as a more precise method of reporting various alloys used in dentistry. The alloys are defined on the basis of the percentage of noble metal content.

High	Predominantly
Noble	Noble	Base
Classification	Alloy	Alloy	Alloy
Weight %	Au., Pd. and/or	Au., Pd. and/or	Au., Pd. and/or
Pt. >60% (with	Pt. >25%	Pt. </=25%
at least 40% Au)

3. Codes to be used for crowns, single restoration only:

D2710

Crown Resin (Laboratory)

98.00

85.00

NOTE: Laboratory processed.

D2720

Crown--Resin with High Noble Metal

161.00

140.00

NOTE: Acrylic veneer.

D2721	Crown--Resin with Predominantly	161.00	140.00
Base Metal

NOTE: Acrylic veneer.

D2722

Crown--Resin with Noble Metal

161.00

140.00

NOTE: Acrylic veneer.

D2750	Crown--Porcelain Fused to High	279.00	253.00
Noble Metal
D2751	Crown--Porcelain Fused to	279.00	253.00
Predominantly Base Metal
D2752	Crown--Porcelain Fused to Noble	279.00	253.00
Metal
D2790	Crown--Full Cast High Noble Metal	161.00	140.00
D2791	Crown--Full Cast Predominantly	161.00	140.00
Base Metal
D2792	Crown--Full Cast Noble Metal	161.00	140.00

(f) Other restorative services:

D2910	Recement Inlay	7.00	6.00
D2920	Recement Crown	7.00	6.00
D2930	Prefabricated Stainless Steel	76.00	70.00
Crown--Primary Tooth

NOTE: Reimbursable only for deciduous teeth.

D2931	Prefabricated Stainless Steel	76.00	70.00
Crown--Permanent Tooth

NOTE: Reimbursable only for permanent posterior teeth up to and including 17 years of age.

D2932

Prefabricated Resin Crown

40.00

35.00

NOTE: For example, Polycarbonate--Reimbursable only for primary and permanent anterior teeth up to and including 15 years of age.

D2933	Prefabricated Stainless Steel	135.50	124.00
Crown with Resin window
D2940	Sedative Filling	10.00	9.00
D2950	Core Buildup including any Pins	49.00	45.00

NOTE 1: And/or post.

NOTE 2: Core of composite or amalgam.

D2951	Pin Retention--Per Tooth, In	6.00	5.00
Addition to Restoration

NOTE 1: Per pin.

NOTE 2: Maximum reimbursable--three pins.

NOTE 3: Not in conjunction with Procedure Code D3950 and D3950 22.

D2952	Cast Post and Core In Addition to	75.00	68.00
Crown

NOTE 1: Post and core fabricated (cast) and cemented as a separate unit from crown.

NOTE 2: Preparatory to crown restoration only.

NOTE 3: Not in conjunction with Procedure Code D3950 and D3950 22.

D2954	Prefabricated Post and Core In	49.00	45.00
Addition to Crown

NOTE 1: Preparatory to crown restoration only.

NOTE 2: Not in conjunction with Procedure Code D3950 and D3950 22.

D2970

Temporary Crown (Fractured Tooth)

29.00

25.00

NOTE: A preformed artificial crown which is fitted over a damaged tooth as an immediate protective device in tooth injury.

*	D2980	Crown Repair, By Report	BR	BR
*	D2999	Unspecified Restorative Procedure,	BR	BR
By Report

N.J. Admin. Code § 10:56-3.4

Public notice: Pursuant to N.J.S.A. 30:4D-2, 3, 5, 6 and 7 and the New Jersey Appropriations Act (P.L. 1988, c.47), maximum fee allowances increased in (b) and (d)8, effective 8/1/1988.
See: 20 N.J.R. 2101(a).
Amended by R.1990 d.456, effective 9/4/1990.
See: 22 N.J.R. 1660(b), 22 N.J.R. 2713(a).
In (h): added "02980----Crown Repair".
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).
Changed Maximum Fee Allowances thoughout.
Amended by R.2001 d.268, effective 8/6/2001.
See: 33 N.J.R. 1554(a), 33 N.J.R. 2666(b).
In (e)3, substituted "beneficiary" for "recipient".
Administrative correction.
See: 34 N.J.R. 4204(a).
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.