ADA Code |
ADA Description |
MAC Specialist |
|
|
|
D0120 |
Periodic oral evaluation - established patient |
50 |
D0145 |
Oral evaluation for a patient under three years of age and counseling with primary caregiver |
50 |
D0150 |
Comprehensive oral evaluation - new or established patient |
77 |
D0160 |
Detailed and extensive oral evaluation - problem focused |
83 |
D0170 |
Re-evaluation - limited, problem focused |
55 |
D0180 |
Comprehensive periodontal evaluation - new or established patient |
76 |
D0425 |
Caries susceptibility to oral diseases |
50 |
D1110 |
Prophylaxis - adult |
67 |
D1120 |
Prophylaxis - child |
50 |
D1203 |
Topical application of fluoride - child |
50 |
D1204 |
Topical application of fluoride - adult |
50 |
D1206 |
Topical fluoride varnish; therapeutic application for moderate to high caries risk patients |
50 |
D1310 |
Nutritional counseling for control of dental disease |
50 |
D1320 |
Tobacco counseling for control and prevention of oral disease |
50 |
D1330 |
Oral hygiene instructions |
50 |
D4910 |
Periodontal maintenance procedures following active therapy |
100 |
D9430 |
Office visit for observation (during regularly scheduled hours) - no other services performed |
78 |
D9910 |
Application of desensitizing medicament |
50 |
ADA Code |
ADA Description |
|
D0210 |
Intraoral - complete series (including bite wings) |
35 |
D0220 |
Intraoral - periapical first film |
35 |
D0230 |
Intraoral - periapical each additional film |
35 |
D0240 |
Intraoral - occlusal film |
35 |
D0250 |
Extraoral - first film |
35 |
D0260 |
Extraoral - each additional film |
35 |
D0270 |
Bitewing - single film |
35 |
D0272 |
Bitewings - two films |
35 |
D0273 |
Bitewings - three films |
35 |
D0274 |
Bitewings - four films |
38 |
D0277 |
Vertical bitewings - 7 to 8 films |
64 |
D0330 |
Panoramic film |
68 |
D0340 |
Cephalometric film |
75 |
FILLINGS AND BASIC SERVICES |
|
|
ADA Code |
ADA Description |
|
D0140 |
Limited oral evaluation - problem focused |
70 |
D0290 |
Posterior - anterior or lateral skull and facial bone survey film |
78 |
D0310 |
Sialography |
190 |
D0415 |
Collection of microorganisms for culture and sensitivity-Bacteriologic Studies for Det of Path |
40 |
D0417 |
Collection and preparation of saliva sample for laboratory diagnostic testing |
53 |
D0418 |
Analysis of saliva sample |
133 |
D0431 |
Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities |
40 |
D0460 |
Pulp vitality tests |
35 |
D0470 |
Diagnostic casts |
67 |
D2140 |
Amalgam - one surface, primary |
77 |
|
permanent |
77 |
D2150 |
Amalgam - two surfaces, primary |
95 |
|
permanent |
95 |
D2160 |
Amalgam - three surfaces, primary |
111 |
|
permanent |
85 |
D2161 |
Amalgam - four or more surfaces, primary |
115 |
|
permanent |
95 |
D2330 |
Resin-based composite - one surface, anterior |
92 |
D2331 |
Resin-based composite - two surfaces, anterior |
110 |
D2332 |
Resin-based composite - three surfaces, anterior |
134 |
D2335 |
Resin-based composite - four or more surfaces or involving incisal angle (anterior) |
159 |
D2390 |
Resin-based composite crown, anterior |
235 |
D2391 |
Resin-based composite - one surface, posterior, Primary |
110 |
|
Permanent |
70 |
D2392 |
Resin-based composite - two surfaces, posterior, Primary |
140 |
|
Permanent |
85 |
D2393 |
Resin-based composite - three surfaces, posterior, Primary |
170 |
|
Permanent |
100 |
D2394 |
Resin-based composite - four or more surfaces, posterior, Primary |
200 |
|
Permanent |
100 |
D2410 |
Gold foil - one surface |
345 |
D2420 |
Gold foil - two surfaces |
437 |
|
|
|
PAIN MANAGEMENT AND ADJUNCTIVE SERVICES |
|
ADA Code |
ADA Description |
|
D9110 |
Palliative (emergency) treatment dental pain - minor procedure |
68 |
D9220 |
Deep sedation/general anesthesia - first 30 minutes |
220 |
D9221 |
Deep sedation/general anesthesia - each additional 1 5 minutes |
107 |
D9230 |
Inhalation of nitrous oxide/analgesia, anxiolysis |
141 |
D9241 |
Intravenous conscious sedation/analgesia - first 30 minutes |
140 |
D9310 |
Consultation - diagnostic service provided by dentist or physician other than requesting dentist or physician |
130 |
D9410 |
House/extended care facility call |
107 |
D9420 |
Hospital or ambulatory surgical center call |
105 |
D9440 |
Office visit - after regular office hours |
75 |
D9450 |
Case presentation, detailed and extensive treatment planning |
52 |
|
|
|
OTHER PREVENTIVE SERVICES |
|
|
ADA Code |
ADA Description |
|
D1351 |
Sealant - per tooth |
33 |
D1510 |
Space maintainer - fixed - unilateral |
176 |
D1515 |
Space maintainer - fixed - bilateral |
240 |
D1520 |
Space maintainer - removable - unilateral |
273 |
D1525 |
Space maintainer - removable - bilateral |
330 |
D1550 |
Re-cementation of space maintainer |
45 |
D1555 |
Removal of fixed space maintainer |
95 |
|
|
|
ORAL SURGERY, GUM TREATMENTS AND PROSTHETIC REPAIR |
|
ADA Code |
ADA Description |
|
D4210 |
Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quad |
900 |
D4211 |
Gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quad |
700 |
D4230 |
Anatomical Crown Exposure (four or more contiguous teeth per quad) |
160 |
D4231 |
Anatomical Crown Exposure (one to three teeth per quad) |
50 |
D4240 |
Ging flap procedure, including root planing - four or more contiguous teeth or tooth bounded spaces per quad |
875 |
D4241 |
Gingival flap procedure, including root planning - one to three contiguous teeth or tooth bounded spaces per quad |
725 |
D4249 |
Clinical crown lengthening - hard tissue |
636 |
D4260 |
Osseous surgery (including flap entry and closure) - four or more contiguous teeth or tooth bounded spaces per quad |
300 |
D4261 |
Osseous surgery (including flap entry and closure) - one to three contiguous teeth or tooth bounded spaces per quad |
960 |
D4263 |
Bone replacement graft - first site in quad |
325 |
D4264 |
Bone replacement graft - each additional site in quad |
250 |
D4270 |
Pedicle soft tissue graft procedure |
498 |
D4271 |
Free soft tissue graft procedure (including donor site surgery) |
635 |
D4273 |
Sub epithelial connective tissue graft .procedures, per tooth |
906 |
D4275 |
Soft tissue allograft |
625 |
D4320 |
Provisional splinting - intracoronal |
230 |
D4321 |
Provisional splinting - extracoronal |
265 |
D4341 |
Periodontal scaling and root planning - four or more teeth per quad |
225 |
D4342 |
Periodontal scaling and root planning - one to three teeth per quad |
110 |
D4355 |
Full mouth debridement to enable comprehensive evaluation and diagnosis |
130 |
D5410 |
Adjust complete denture - maxillary |
61 |
D5411 |
Adjust complete denture - mandibular |
61 |
D5421 |
Adjust partial denture - maxillary |
61 |
D5422 |
Adjust partial denture - mandibular |
61 |
D5510 |
Repair broken complete denture base |
125 |
D5520 |
Replace missing or broken teeth - complete denture (each tooth) |
94 |
D5610 |
Repair resin denture base |
110 |
D5620 |
Repair cast framework |
140 |
D5630 |
Repair or replace broken clasp |
134 |
D5640 |
Replace broken teeth - per tooth |
120 |
D5650 |
Add tooth to existing partial denture |
140 |
D5660 |
Add clasp to existing partial denture |
160 |
D5710 |
Rebase complete maxillary denture |
370 |
D5711 |
Rebase complete mandibular denture |
370 |
D5720 |
Rebase maxillary partial denture |
290 |
D5721 |
Rebase mandibular partial denture |
290 |
D5730 |
Reline complete maxillary denture (chairside) |
188 |
D5731 |
Reline complete mandibular denture (chairside) |
188 |
D5740 |
Reline maxillary partial denture (chairside) |
188 |
D5741 |
Reline mandibular partial denture (chairside) |
188 |
D5620 |
Reline complete maxillary denture (lab) |
320 |
D5621 |
Reline complete mandibular denture (lab) |
320 |
D5760 |
Reline maxillary partial denture (lab) |
320 |
D5761 |
Reline mandibular partial denture (lab) |
320 |
D5850 |
Tissue conditioning, maxillary |
95 |
D5851 |
Tissue conditioning, mandibular |
95 |
D6090 |
Repair implant supported prosthesis |
515 |
D6091 |
Replacement of semi-precision or precision attachment of implant/abutment supported prosthesis, per attachment |
424 |
D6092 |
Recement implant/abutment supported crown |
130 |
D6093 |
Recement implant/abutment supported fixed partial denture |
130 |
D6095 |
Repair implant abutment |
200 |
D6100 |
Implant removal |
300 |
D6930 |
Recement fixed partial denture |
100 |
D7111 |
Extraction, coronal remnants, deciduous tooth |
95 |
D7140 |
Extraction, erupted tooth or exposed root |
95 |
D7210 |
Surgical removal of erupted tooth |
154 |
D7220 |
Removal of impacted tooth - soft tissue |
195 |
D7230 |
Removal of impacted tooth - partial bony |
225 |
D7240 |
Removal of impacted tooth - completely bony |
290 |
D7241 |
Removal of impacted tooth - completely bony, with unusual surgical complications |
305 |
D7250 |
Surgical removal residual tooth roots (cutting procedure) |
165 |
D7260 |
Oroantral fistula closure |
501 |
D7270 |
Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth |
269 |
D7280 |
Surgical access of an unerupted tooth |
270 |
D7282 |
Mobilization of erupted or malpositioned tooth to aid eruption |
250 |
D7283 |
Placement of device to facilitate eruption of impacted tooth |
115 |
D7285 |
Biopsy of oral tissue - hard (bone, tooth) |
425 |
D7286 |
Biopsy of oral tissue - soft |
205 |
D7310 |
Alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quad |
210 |
D7311 |
Alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per quad |
175 |
D7320 |
Alveoloplasty not in conjunction with extractions -four or more teeth or tooth spaces, per quad |
285 |
D7321 |
Alveoloplasty not in conjunction with extractions - one to three teeth or tooth spaces, per quad |
121 |
D7340 |
Vestibuloplasty - uncomplicated |
975 |
D7350 |
Vestibuloplasty - complicated |
1685 |
D7410 |
Excision of benign lesion up to 1.25 cm |
650 |
D7411 |
Excision of benign lesion greater than 1.25 cm |
650 |
D7412 |
Excision of benign lesion, complicated |
650 |
D7413 |
Excision of malignant lesion up to 1.25 cm |
800 |
D7414 |
Excision of malignant lesion greater than 1.25 cm |
800 |
D7415 |
Excision of malignant lesion, complicated |
800 |
D7440 |
Excision of malignant tumor - lesion diameter up to 1.25 cm |
800 |
D7441 |
Excision of malignant tumor - lesion diameter greater than 1.25 cm |
800 |
D7450 |
Removal of benign odontogenic cyst or tumor- lesion diameter up to 1.25 cm |
650 |
D7451 |
Removal of benign odontogenic cyst or tumor - lesion diameter greater than 1 .25 cm |
650 |
D7460 |
Removal of benign nonodontogenic cyst or tumor - lesion diameter up to 1 .25 cm |
650 |
D7461 |
Removal of benign nonodontogenic cyst or tumor - lesion diameter greater than 1.25 cm |
665 |
D7471 |
Removal of lateral exostosis (maxilla or mandible) |
450 |
D7472 |
Removal of torus palatinus |
450 |
D7473 |
Removal of torus mandibularis |
478 |
D7485 |
Surgical reduction of osseous tuberosity |
550 |
D7510 |
Incision and drainage of abscess - intraoral soft tissue |
143 |
D7511 |
Incision and drainage of abscess - intraoral soft tissue - complicated (includes drainage of multiple fascial spaces) |
562 |
D7520 |
Incision and drainage of abscess - extraoral soft tissue |
562 |
D7521 |
Incision and drainage of abscess - extraoral soft tissue - complicated (includes drainage of multiple fascial spaces) |
562 |
D7530 |
Removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue |
200 |
D7540 |
Removal of reaction producing foreign bodies, musculoskeletal system |
225 |
D7550 |
Partial ostectomy/sequestrectomy for removal of non-vital bone |
206 |
D7560 |
Maxillary sinusotomy for removal of tooth fragment or foreign body |
1289 |
D7610 |
Maxilla - open reduction (simple) |
3694 |
D7620 |
Maxilla - closed reduction (simple) |
2829 |
D7630 |
Mandible - open reduction (simple) |
4151 |
D7640 |
Mandible - closed reduction (simple) |
3060 |
D7650 |
Malar and/or zygomatic arch - open reduction (simple) |
2599 |
D7660 |
Malar and/or zygomatic arch - closed reduction (simple) |
1346 |
D7670 |
Alveolus - closed reduction, may include stabilization of teeth (simple) |
902 |
D7671 |
Alveolus - open reduction, may include stabilization of teeth (simple) |
1913 |
D7710 |
Maxilla - open reduction (compound) , |
4358 |
D7720 |
Maxilla - closed reduction (compound) |
2987 |
D7730 |
Mandible - open reduction (compound) |
5383 |
D7740 |
Mandible - closed reduction (compound) |
3036 |
D7750 |
Malar and/or zygomatic arch - open reduction (compound) |
4181 |
D7760 |
Malar and/or zygomatic arch - closed reduction (compound) |
1570 |
D7770 |
Alveolus - open reduction stabilization of teeth (compound) |
2034 |
D7771 |
Alveolus - closed reduction stabilization of teeth (compound) |
1561 |
D7960 |
Frenulectomy - also known as frenectomy or frenotomy - separate procedure not incidental to another |
251 |
D7963 |
Frenuloplasty |
423 |
D7970 |
Excision of hyperplastic tissue - per arch |
263 |
D7971 |
Excision of pericoronal gingiva |
250 |
D9120 |
Fixed partial denture sectioning |
44 |
|
|
|
CROWNS AND MAJOR SERVICES |
|
D2510 |
Inlay - metallic - one surface |
455 |
D2520 |
Inlay - metallic - two surfaces |
475 |
D2530 |
Inlay - metallic - three or more surfaces |
487 |
D2542 |
Onlay - metallic - two surfaces |
465 |
D2543 |
Onlay - metallic - three surfaces |
560 |
D2544 |
Onlay - metallic - four or more surfaces |
570 |
D2610 |
Inlay - porcelain/ceramic - one surface |
445 |
D2620 |
Inlay - porcelain/ceramic - two surfaces |
546 |
D2630 |
Inlay - porcelain/ceramic - three or more surfaces |
592 |
D2642 |
Onlay - porcelain/ceramic - two surfaces |
660 |
D2643 |
Onlay - porcelain/ceramic - three surfaces |
685 |
D2644 |
Onlay - porcelain/ceramic - four or more surfaces |
698 |
D2650 |
Inlay - resin-based composite - one surface |
378 |
D2651 |
Inlay - resin-based composite - two surfaces |
445 |
D2652 |
Inlay - resin-based composite - three or more surfaces |
489 |
D2662 |
Onlay - resin-based composite - two surfaces |
450 |
D2663 |
Onlay - resin-based composite - three surfaces |
487 |
D2664 |
Onlay - resin-based composite - four or more surfaces |
510 |
D2710 |
Crown - resin-based composite (indirect) |
455 |
D2712 |
Crown - 3/4 resin-based composite (indirect) |
700 |
D2720 |
Crown - resin with high noble metal |
685 |
D2721 |
Crown - resin with predominantly base metal |
632 |
D2722 |
Crown - resin with noble metal |
641 |
D2740 |
Crown - porcelain/ceramic substrate |
740 |
D2750 |
Crown - porcelain fused to high noble metal |
740 |
D2751 |
Crown - porcelain fused to predominantly base metal |
690 |
D2752 |
Crown - porcelain fused to noble metal |
710 |
D2780 |
Crown - 3/4 cast high noble metal |
746 |
D2781 |
Crown - 3/4 cast predominantly base metal |
694 |
D2782 |
Crown - 3/4 cast noble metal |
715 |
D2783 |
Crown - 3/4 porcelain/ceramic |
770 |
D2790 |
Crown - full cast high noble metal |
756 |
D2791 |
Crown - full cast predominantly base metal |
700 |
D2792 |
Crown - full cast noble metal |
732 |
D2794 |
Crown - titanium |
626 |
D2910 |
Recement inlay, onlay, or partial coverage restoration |
66 |
D2915 |
Recement cast or prefabricated post and core |
57 |
D2920 |
Recement crown |
57 |
D2930 |
Prefabricated stainless steel crown - primary tooth |
150 |
D2931 |
Prefabricated stainless steel crown - permanent tooth |
185 |
D2932 |
Prefabricated resin crown |
210 |
D2933 |
Prefabricated stainless steel crown with resin window |
200 |
D2934 |
Prefabricated esthetic coated stainless steel crown - primary tooth |
199 |
D2940 |
Protective restoration |
66 |
D2950 |
Crown buildup - including any pins |
150 |
D2951 |
Pin retention - per tooth in addition to restoration |
45 |
D2952 |
Post and core in addition to crown, indirectly fabricated |
294 |
D2954 |
Prefabricated post & core in addition to crown |
200 |
D2955 |
Post removal (not in conjunction with endodontic therapy) |
139 |
D2970 |
Temporary crown (fractured tooth) |
165 |
D2980 |
Crown repair |
0 |
D3110 |
Pulp cap - direct (excluding final restoration) |
55 |
D3120 |
Pulp cap - indirect (excluding final restoration) |
44 |
D3220 |
Therapeutic pulpotomy (excluding final restoration) |
114 |
D3222 |
Partial pulpotomy for apexogenesis - permanent tooth with incomplete root development |
114 |
D3230 |
Pulpal therapy - anterior, primary tooth (excluding final restoration) |
135 |
D3240 |
Pulpal therapy - posterior, primary tooth (excluding final restoration) |
141 |
D3310 |
Endodontic therapy, anterior tooth (excluding final restoration) |
610 |
D3320 |
Endodontic therapy, bicuspid tooth (excluding final restoration) |
745 |
D3330 |
Endodontic therapy, molar (excluding final restoration) |
950 |
D3346 |
Retreatment of previous root canal therapy- anterior |
917 |
D3347 |
Retreatment of previous root canal therapy- bicuspid |
1080 |
D3348 |
Retreatment of previous root canal therapy- molar |
1336 |
D3351 |
Apexification/recalcification/pulpal regeneration - initial visit ' |
240 |
D3352 |
Apexification/recalcification/pulpal regeneration - interim medication replacement |
139 |
D3353 |
Apexification/recalcification - final visit |
560 |
D3410 |
Apicoectomy/periradicular surgery - anterior |
670 |
D3421 |
Apicoectomy/periradicular surgery - bicuspid (first root) |
785 |
D3425 |
Apicoectomy/periradicular surgery - molar (first root) |
825 |
D3426 |
Apicoectomy/periradicular surgery (each additional root) |
183 |
D3430 |
Retrograde filling - per root |
130 |
D3450 |
Root amputation - per root |
207 |
D3920 |
Hemisection - (including root removal); not including root canal therapy |
305 |
D3950 |
Canal preparation and fitting of preformed dowel or post |
125 |
|
|
|
MAJOR PROSTHETIC SERVICES |
|
|
ADA Code |
ADA Description |
|
D5110 |
Complete denture - maxillary |
1385 |
D5120 |
Complete denture - mandibular |
1385 |
D5130 |
Immediate denture - maxillary |
1540 |
D5140 |
Immediate denture - mandibular |
1540 |
D5211 |
Maxillary partial denture - resin base (including any conventional clasps, rests, and teeth) |
810 |
D5212 |
Mandibular partial denture - resin base (including any conventional clasps, rests, and teeth) |
810 |
D5213 |
Max partial denture -cast metal frame with resin denture bases (including clasps, rests, teeth) |
1365 |
D5214 |
Mand partial denture -cast metal frame with resin denture bases (including clasps, rests, teeth) |
1365 |
D5225 |
Maxillary partial denture - flexible base (including clasps, rests, and teeth) |
1152 |
D5226 |
Mandibular partial denture - flexible base (including clasps, rests, and teeth) |
1152 |
D5281 |
Removable unilateral partial denture - one piece cast metal (including clasps and teeth) |
540 |
D5670 |
Replace all teeth and acrylic on cast metal framework (maxillary) |
790 |
D5671 |
Replace all teeth and acrylic on cast metal framework (mandibular) |
790 |
D5810 |
Interim complete denture (maxillary) |
450 |
D5811 |
Interim complete denture (mandibular) |
450 |
D5820 |
Interim partial denture (maxillary) |
360 |
D5821 |
Interim partial denture (mandibular) |
360 |
D6010 |
Surgical placement of implant body: endosteal implant |
1875 |
D6012 |
Surgical Placement of Interim Implant Body for Transitional Prosthetics: Endosteal Implant |
650 |
D6040 |
Surgical placement: eposteal implant |
6215 |
D6050 |
Surgical placement : transosteal implant |
4250 |
D6056 |
Prefabricated abutment - includes placement |
650 |
D6057 |
Custom abutment - includes placement |
650 |
D6058 |
Abutment supported porcelain/ceramic crown |
860 |
D6059 |
Abutment supported porcelain fused to metal crown (high noble metal) |
900 |
D6060 |
Abutment supported porcelain fused to metal crown (predominantly base metal) |
760 |
D6061 |
Abutment supported porcelain fused to metal crown (noble metal) |
834 |
D6062 |
Abutment supported cast metal crown (high noble metal) |
840 |
D6063 |
Abutment supported cast metal crown (predominantly base metal) |
775 |
D6064 |
Abutment supported cast metal crown (noble metal) |
840 |
D6065 |
Implant supported porcelain/ceramic crown |
965 |
D6066 |
Implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) |
965 |
D6067 |
Implant supported metal crown (titanium, titanium alloy, high noble metal) |
945 |
D6068 |
Abutment supported retainer for porcelain/ceramic FPD |
865 |
D6069 |
Abutment supported retainer for porcelain fused to metal FPD (high noble metal) |
850 |
D6070 |
Abutment supported retainer for porcelain fused to metal FPD (predominantly base metal) |
750 |
D6071 |
Abutment supported retainer for porcelain fused to metal FPD (noble metal) |
785 |
D6072 |
Abutment supported retainer for cast metal FPD (high noble metal) |
850 |
D6073 |
Abutment supported retainer for cast meta! FPD (predominantly base metal) |
779 |
D6074 |
Abutment supported retainer for cast metal FPD (noble metal) |
840 |
D6075 |
Implant supported retainer for ceramic FPD |
955 |
D6076 |
Implant supported retainer for porcelain fused to metal FPD (ti, ti alloy, high noble metal) |
935 |
D6077 |
Implant supported retainer for cast metal FPD (titanium, titanium alloy, high noble metal) |
930 |
D6078 |
Implant/abutment supported fixed denture for completely edentulous arch |
2375 |
D6079 |
Implant/abutment supported fixed denture for partially edentulous arch |
1590 |
D6080 |
Implant maintenance procedures |
225 |
D6094 |
Abutment supported crown (titanium) |
710 |
D6194 |
Abutment supported retainer crown for FPD (titanium) |
829 |
D6205 |
Pontic - indirect resin based composite |
678 |
D6210 |
Pontic - cast high noble metal |
756 |
D6211 |
Pontic - cast predominantly base metal |
700 |
D6212 |
Pontic - cast noble metal |
735 |
D6214 |
Pontic - titanium |
735 |
D6240 |
Pontic - porcelain fused to high noble metal |
740 |
D6241 |
Pontic - porcelain fused to predominantly base metal |
690 |
D6242 |
Pontic - porcelain fused to noble metal |
715 |
D6245 |
Pontic - porcelain/ceramic |
740 |
D6250 |
Pontic - resin with high noble metal |
716 |
D6251 |
Pontic - resin with predominantly base metal |
655 |
D6252 |
Pontic - resin with noble metal |
710 |
D6253 |
Provisional pontic |
1375 |
D6545 |
Cast metal retainer for resin bonded fixed prosthesis |
355 |
D6548 |
Porcelain/ceramic retainer for resin bonded fixed prosthesis |
590 |
D6600 |
Inlay - porcelain/ceramic, two surfaces |
563 |
D6601 |
Inlay - porcelain/ceramic, three or more surfaces |
611 |
D6602 |
Inlay - cast high noble metal, two surfaces |
615 |
D6603 |
Inlay - cast high noble metal, three or more surfaces |
675 |
D6604 |
Inlay - cast predominantly base metal, two surfaces |
562 |
D6605 |
Inlay - cast predominantly base metal, three or more surfaces |
580 |
D6606 |
Inlay - cast noble metal, two surfaces |
560 |
D6607 |
Inlay - cast noble metal, three or more surfaces |
615 |
D6608 |
Onlay - porcelain/ceramic, two surfaces |
663 |
D6609 |
Onlay - porcelain/ceramic, three or more surfaces |
725 |
D6610 |
Onlay - cast high noble metal, two surfaces |
675 |
D6611 |
Onlay - cash high noble metal, three or more surfaces |
569 |
D6612 |
Onlay - cast predominantly base metal, two surfaces |
562 |
D66I3 |
Onlay - cast predominantly base metal, three or more surfaces |
640 |
D6614 |
Onlay - cast noble metal, two surfaces |
615 |
D6615 |
Onlay - cast noble metal, three or more surfaces |
675 |
D6624 |
Inlay - titanium |
600 |
D6634 |
Onlay - titanium |
655 |
D6710 |
Crown - indirect resin based composite |
651 |
D6720 |
Crown - resin with high noble metal |
800 |
D6721 |
Crown - resin with predominantly base, metal |
685 |
D6722 |
Crown - resin with noble metal |
710 |
D6740 |
Crown - porcelain/ceramic |
740 |
D6750 |
Crown - porcelain fused to high noble metal |
740 |
D6751 |
Crown - porcelain fused to predominantly base metal |
690 |
D6752 |
Crown - porcelain fused to noble metal |
715 |
D6780 |
Crown - 3/4 cast high noble metal |
750 |
D6781 |
Crown - 3/4 cast predominantly base metal |
692 |
D6782 |
Crown - 3/4 cast noble metal |
720 |
D6783 |
Crown - 3/4 porcelain/ceramic |
775 |
D6790 |
Crown - full cast high noble metal |
758 |
D6791 |
Crown - full cast predominantly base metal |
700 |
D6792 |
Crown - full cast noble metal |
735 |
D6793 |
Provisional retainer crown |
375 |
D6794 |
Crown - titanium |
639 |
D6970 |
Post and core in addition to fixed partial denture retainer, indirectly fabricated |
273 |
D6972 |
Prefabricated post and core in addition to fixed partial denture retainer |
200 |
D6973 |
Core build up for retainer, including any pins |
185 |
D6975 |
Coping - metal |
420 |