ADECD41 ; IHS/SET/HMW - ADA CODE TABLE UPDATE (CDT4) ;
;;6.0;ADE;**12**;MAR 25, 1999
;
;;CODE^0180^COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT
;;SVC^4^45^V07.8
;;SYN^PERIO EVAL
;;NOP
;;USE
;;This procedure is indicated for patients showing signs or symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes.
;;It includes evaluation of periodontal conditions, probing and charting, evaluation and recording of the patient's dental and medical history and general health assessment.
;;It may include the evaluation and recording of dental caries, missing or unerupted teeth, restorations, occlusal relationships and oral cancer screening.
;;CODE^2390^RESIN-BASED COMPOSITE CROWN, ANTERIOR
;;SVC^4^35^521.0
;;SYN^RESIN CROWN ANT
;;USE
;;Full resin-based composite coverage of tooth.
;;CODE^2391^RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR
;;SVC^3^15^521.0
;;SYN^RESIN 1S POST
;;USE
;;Used to restore a carious lesion into the dentin or a deeply eroded area into the dentin. Not a preventive procedure.
;;Full resin-based composite coverage of tooth.
;;CODE^2392^RESIN-BASED COMPOSITE - TWO SURFACE, POSTERIOR
;;SVC^9^20^521.0
;;SYN^RESIN 2S POST
;;CODE^2393^RESIN-BASED COMPOSITE - THREE SURFACE, POSTERIOR
;;SVC^9^30^521.0
;;SYN^RESIN 3S POST
;;CODE^2394^RESIN-BASED COMPOSITE - FOUR SURFACE, POSTERIOR
;;SVC^9^30^521.0
;;SYN^RESIN 4S POST
;;CODE^4241^GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT
;;SVC^4^40^523.9
;;SYN^GINGIVAL FLAP
;;USE
;;Surgical debridement of the root surface and the removal of granulation tissue following the resection or reflection of soft tissue flap.
;;Osseous recontouring is not accomplished in conjunction with this procedure. May include open flap curettage, reverse bevel flap surgery, modified Kirkland flap procedure, Widman surgery,
;;and modified Widman surgery. This procedure is performed in the presence of moderate to deep probing depths, loss of probing attachment, need to maintain esthetics,
;;and need for increased access to the root surface and alveolar bone.
;;CODE^4261^OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - ONE TO THREE TEETH, PER QUADRANT
;;MNE^OSSEOUS SURGERY
;;SVC^5^50^523.9
;;SYN^OSSEOUS SURG
;;USE
;;This procedure modifies the bony support of the teeth by reshaping the alveolar process to achieve a more physiologic form.
;;This may include the removal of supporting bone (ostectomy) or non-supporting bone.
;;Other separate procedures including, but not limited to, D3450, D3920, D4263, D4264, D4266, D4267, D6010 and D7140 may be required concurrent to D4260.
;;CODE^4265^BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION
;;SVC^5^15^523.9
;;SYN^BIOLOGIC MATERIALS
;;USE
;;Biologic materials may be used alone or with other regenerative substrates such as bone and barrier membranes, depending upon their formulation and the presentation of the periodontal defect.
;;Does not include surgical entry and closure, wound debridement, osseous contouring, or the placement of graft materials and/or barrier membranes.
;;CODE^4275^SOFT TISSUE ALLOGRAFT
;;SVC^5^60^523.9
;;SYN^SOFT ALLOGRAFT
;;USE
;;Procedure is performed to create or augment the gingiva, with or without root coverage.
;;This may be used to eliminate the pull of the frena and muscle attachments, to extend the vestibular fornix, and correct localized gingival recession. There is no donor site.
;;CODE^4276^COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT
;;SVC^5^60^523.9
;;SYN^CONN TISS GRAFT
;;USE
;;Advanced gingival recession often cannot be corrected with a single procedure. Combined tissue grafting procedures are needed to achieve the desired outcome.
;;CODE^4342^PERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT
;;SVC^3^20^523.9
;;SYN^ROOT PLANE/QUAD
;;USE
;;This procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces.
;;It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature.
;;Root planing is the definitive procedure designed for the removal of cementum and dentin that is rough, and/or permeated by calculus or contaminated with toxins or microorganisms.
;;Some soft tissue removal occurs. This procedure may be used as a definitive treatment in some stages of periodontal disease and/or as a part of pre-surgical procedures in others.
;;CODE^5670^REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MAXILLARY)
;;SVC^5^60^525.1
;;SYN^REPLACE TEETH ACRYL (MAX)
;;CODE^5671^REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MANDIBULAR)
;;SVC^5^60^525.1
;;SYN^REPLACE TEETH ACRYL (MAND)
;;CODE^6053^IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR COMPLETELY EDENTULOUS ARCH
;;SVC^5^160^V52.3
;;SYN^IMPLANT/ABUTMENT DENTURE EDENT
;;CODE^6054^IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH
;;SVC^5^160^V52.3
;;SYN^IMPLANT/ABUTMENT DENTURE PART EDENT
;;CODE^6253^PROVISIONAL PONTIC
;;SVC^5^0^V52.3
;;SYN^PROVISIONAL PONTIC
;;USE
;;Pontic utilized as an interim of at least six months duration during restorative treatment to allow adequate time for healing or completion of other procedures.
;;This is not to be used as a temporary pontic for routine prosthetic fixed partial dentures.
;;CODE^6600^INLAY - PORCELAIN/CERAMIC, TWO SURFACES
;;SVC^9^65^V52.3
;;SYN^INLAY PORCELAIN/CERAMIC, 2-SFC
;;CODE^6601^INLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
;;SVC^9^70^V52.3
;;SYN^INLAY PORCELAIN/CERAMIC, 3+SFC
;;CODE^6602^INLAY - CAST HIGH NOBLE METAL, TWO SURFACES"
;;SVC^9^65^V52.3
;;SYN^INLAY - CAST HI NOBLE, 2-SFC
;;CODE^6603^INLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES
;;SVC^9^70^V52.3
;;SYN^INLAY - CAST HI NOBLE, 3+SFC
;;CODE^6604^INLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES
;;SVC^9^65^V52.3
;;SYN^INLAY - CAST BASE, 2-SFC
;;CODE^6605^INLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES
;;SVC^9^70^V52.3
;;SYN^INLAY - CAST BASE, 3+SFC
;;CODE^6606^INLAY - CAST NOBLE METAL, TWO SURFACES
;;SVC^9^65^V52.3
;;SYN^INLAY - CAST NOBLE, 2-SFC
;;CODE^6607^INLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
;;SVC^9^70^V52.3
;;SYN^INLAY - CAST NOBLE, 3+SFC
;;CODE^6608^ONLAY -PORCELAIN/CERAMIC, TWO SURFACES
;;SVC^9^65^V52.3
;;SYN^ONLAY - PORC/CER 2-SFC
;;CODE^6609^ONLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
;;SVC^9^70^V52.3
;;SYN^ONLAY - PORC/CER 3+SFC
;;CODE^6610^ONLAY - CAST HIGH NOBLE METAL, TWO SURFACES
;;SVC^9^65^V52.3
;;SYN^ONLAY - HI NOBLE 2-SFC
;;CODE^6611^ONLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES
;;SVC^9^70^V52.3
;;SYN^ONLAY - HI NOBLE 3+SFC
;;CODE^6612^ONLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES
;;SVC^9^65^V52.3
;;SYN^ONLAY - BASE 2-SFC
;;CODE^6613^ONLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES
;;SVC^9^70^V52.3
;;SYN^ONLAY - BASE 3+SFC
;;CODE^6614^ONLAY - CAST NOBLE METAL, TWO SURFACES
;;SVC^9^65^V52.3
;;SYN^ONLAY - NOBLE 2-SFC
;;CODE^6615^ONLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
;;SVC^9^70^V52.3
;;SYN^ONLAY - NOBLE 3+SFC
;;CODE^6793^PROVISIONAL RETAINER CROWN
;;SVC^5^115^V52.3
;;SYN^PROVISIONAL RETAINER CROWN
;;USE
;;Retainer crown utilized as an interim of at least six months duration during restorative treatment to allow adequate time for healing or completion of other procedures.
;;This is not to be used as a temporary retainer crown for routine prosthetic fixed partial dentures.
;;CODE^6985^PEDIATRIC PARTIAL DENTURE, FIXED
;;SVC^5^45^V52.3
;;SYN^PED PART DENT
;;CODE^7111^CORONAL REMNANTS - DECIDUOUS TOOTH
;;SVC^1^5^520.6
;;SYN^CORONAL REMNANTS
;;USE
;;Includes soft tissue-retained coronal remnants.
;;CODE^7140^EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL)
;;SVC^1^15^520.6
;;SYN^EXTRACTION
;;USE
;;Includes routine removal of tooth structure and closure, as necessary
;;CODE^7261^PRIMARY CLOSURE OF A SINUS PERFORATION
;;SVC^5^30^520.6
;;SYN^SINUS CLOSURE
;;USE
;;Subsequent to surgical removal of tooth, exposure of sinus requiring repair, or immediate closure of oroantral or oralnasal communication in absence of fistulus tract.
;;CODE^7282^MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION
;;SVC^5^60^520.6
;;SYN^MOBILIZATION
;;USE
;;To move/luxate teeth to eliminate ankyolosis; not in conjunction with an extraction.
;;CODE^7287^CYTOLOGY SAMPLE COLLECTION
;;SVC^1^5^520.6
;;SYN^CYTOLOGY
;;USE
;;For collection of oral cytology sample via mild scraping of the oral mucosa.
;;CODE^7411^EXCISION OF BENIGN LESION GREATER THAN 1.25 CM
;;SVC^3^35^520.6
;;SYN^EXCISION BENIGN LESION
;;CODE^7412^EXCISION OF BENIGN LESION, COMPLICATED
;;SVC^3^60^520.6
;;SYN^EXCISION BENIGN LESION COMPL
;;USE
;;Requires extensive undermining with advancement or rotational flap closure
;;CODE^7413^EXCISION OF MALIGNANT LESION UP TO 1.25 CM
;;SVC^3^25^520.6
;;SYN^EXCISION MALIGNANT LESION
;;CODE^7414^EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM
;;SVC^3^30^520.6
;;SYN^EXCISION MALIGNANT LESION > 1.25CM
;;CODE^7415^EXCISION OF MALIGNANT LESION, COMPLICATED
;;SVC^3^75^520.6
;;SYN^EXCISION MALIGNANT LESION COMPL
;;CODE^7472^REMOVAL OF TORUS PALATINUS
;;SVC^4^30^520.6
;;SYN^REMOVAL TORUS PALATINUS
;;CODE^7473^REMOVAL OF TORUS MANDIBULARIS
;;SVC^4^30^520.6
;;SYN^REMOVAL TORUS MANDIBULARIS
;;CODE^7485^SURGICAL REDUCTION OF OSSEOUS TUBEROSITY
;;SVC^4^20^520.6
;;SYN^SURGICAL REDUCTION OSSEOUS TUBEROSITY
;;CODE^7671^ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
;;SVC^1^180^520.6
;;SYN^ALVEOLUS - OPEN REDUCTION
;;USE
;;Teeth may be wired, banded or splinted together to prevent movement.
;;CODE^7771^ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH
;;SVC^1^120^520.6
;;SYN^ALVEOLUS, CLOSED REDUCTION
;;USE
;;Fractured bone(s) are exposed to mouth or outside the face.
;;CODE^7972^SURGICAL REDUCTION OF FIBROUS TUBEROSITY
;;SVC^4^20^520.6
;;SYN^SURGICAL REDUCTION FIBROUS TUBEROSITY
;;CODE^9450^CASE PRESENTATION, DETAILED AND EXTENSIVE TREATMENT PLANNING
;;SVC^3^15^521.0
;;SYN^CASE PRESENTATION
;;NOP
;;USE
;;Case presentation involves detailed and extensive treatment planning.
ADECD41 ; IHS/SET/HMW - ADA CODE TABLE UPDATE (CDT4) ;
+1 ;;6.0;ADE;**12**;MAR 25, 1999
+2 ;
+3 ;;CODE^0180^COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT
+4 ;;SVC^4^45^V07.8
+5 ;;SYN^PERIO EVAL
+6 ;;NOP
+7 ;;USE
+8 ;;This procedure is indicated for patients showing signs or symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes.
+9 ;;It includes evaluation of periodontal conditions, probing and charting, evaluation and recording of the patient's dental and medical history and general health assessment.
+10 ;;It may include the evaluation and recording of dental caries, missing or unerupted teeth, restorations, occlusal relationships and oral cancer screening.
+11 ;;CODE^2390^RESIN-BASED COMPOSITE CROWN, ANTERIOR
+12 ;;SVC^4^35^521.0
+13 ;;SYN^RESIN CROWN ANT
+14 ;;USE
+15 ;;Full resin-based composite coverage of tooth.
+16 ;;CODE^2391^RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR
+17 ;;SVC^3^15^521.0
+18 ;;SYN^RESIN 1S POST
+19 ;;USE
+20 ;;Used to restore a carious lesion into the dentin or a deeply eroded area into the dentin. Not a preventive procedure.
+21 ;;Full resin-based composite coverage of tooth.
+22 ;;CODE^2392^RESIN-BASED COMPOSITE - TWO SURFACE, POSTERIOR
+23 ;;SVC^9^20^521.0
+24 ;;SYN^RESIN 2S POST
+25 ;;CODE^2393^RESIN-BASED COMPOSITE - THREE SURFACE, POSTERIOR
+26 ;;SVC^9^30^521.0
+27 ;;SYN^RESIN 3S POST
+28 ;;CODE^2394^RESIN-BASED COMPOSITE - FOUR SURFACE, POSTERIOR
+29 ;;SVC^9^30^521.0
+30 ;;SYN^RESIN 4S POST
+31 ;;CODE^4241^GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT
+32 ;;SVC^4^40^523.9
+33 ;;SYN^GINGIVAL FLAP
+34 ;;USE
+35 ;;Surgical debridement of the root surface and the removal of granulation tissue following the resection or reflection of soft tissue flap.
+36 ;;Osseous recontouring is not accomplished in conjunction with this procedure. May include open flap curettage, reverse bevel flap surgery, modified Kirkland flap procedure, Widman surgery,
+37 ;;and modified Widman surgery. This procedure is performed in the presence of moderate to deep probing depths, loss of probing attachment, need to maintain esthetics,
+38 ;;and need for increased access to the root surface and alveolar bone.
+39 ;;CODE^4261^OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - ONE TO THREE TEETH, PER QUADRANT
+40 ;;MNE^OSSEOUS SURGERY
+41 ;;SVC^5^50^523.9
+42 ;;SYN^OSSEOUS SURG
+43 ;;USE
+44 ;;This procedure modifies the bony support of the teeth by reshaping the alveolar process to achieve a more physiologic form.
+45 ;;This may include the removal of supporting bone (ostectomy) or non-supporting bone.
+46 ;;Other separate procedures including, but not limited to, D3450, D3920, D4263, D4264, D4266, D4267, D6010 and D7140 may be required concurrent to D4260.
+47 ;;CODE^4265^BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION
+48 ;;SVC^5^15^523.9
+49 ;;SYN^BIOLOGIC MATERIALS
+50 ;;USE
+51 ;;Biologic materials may be used alone or with other regenerative substrates such as bone and barrier membranes, depending upon their formulation and the presentation of the periodontal defect.
+52 ;;Does not include surgical entry and closure, wound debridement, osseous contouring, or the placement of graft materials and/or barrier membranes.
+53 ;;CODE^4275^SOFT TISSUE ALLOGRAFT
+54 ;;SVC^5^60^523.9
+55 ;;SYN^SOFT ALLOGRAFT
+56 ;;USE
+57 ;;Procedure is performed to create or augment the gingiva, with or without root coverage.
+58 ;;This may be used to eliminate the pull of the frena and muscle attachments, to extend the vestibular fornix, and correct localized gingival recession. There is no donor site.
+59 ;;CODE^4276^COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT
+60 ;;SVC^5^60^523.9
+61 ;;SYN^CONN TISS GRAFT
+62 ;;USE
+63 ;;Advanced gingival recession often cannot be corrected with a single procedure. Combined tissue grafting procedures are needed to achieve the desired outcome.
+64 ;;CODE^4342^PERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT
+65 ;;SVC^3^20^523.9
+66 ;;SYN^ROOT PLANE/QUAD
+67 ;;USE
+68 ;;This procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces.
+69 ;;It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature.
+70 ;;Root planing is the definitive procedure designed for the removal of cementum and dentin that is rough, and/or permeated by calculus or contaminated with toxins or microorganisms.
+71 ;;Some soft tissue removal occurs. This procedure may be used as a definitive treatment in some stages of periodontal disease and/or as a part of pre-surgical procedures in others.
+72 ;;CODE^5670^REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MAXILLARY)
+73 ;;SVC^5^60^525.1
+74 ;;SYN^REPLACE TEETH ACRYL (MAX)
+75 ;;CODE^5671^REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MANDIBULAR)
+76 ;;SVC^5^60^525.1
+77 ;;SYN^REPLACE TEETH ACRYL (MAND)
+78 ;;CODE^6053^IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR COMPLETELY EDENTULOUS ARCH
+79 ;;SVC^5^160^V52.3
+80 ;;SYN^IMPLANT/ABUTMENT DENTURE EDENT
+81 ;;CODE^6054^IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH
+82 ;;SVC^5^160^V52.3
+83 ;;SYN^IMPLANT/ABUTMENT DENTURE PART EDENT
+84 ;;CODE^6253^PROVISIONAL PONTIC
+85 ;;SVC^5^0^V52.3
+86 ;;SYN^PROVISIONAL PONTIC
+87 ;;USE
+88 ;;Pontic utilized as an interim of at least six months duration during restorative treatment to allow adequate time for healing or completion of other procedures.
+89 ;;This is not to be used as a temporary pontic for routine prosthetic fixed partial dentures.
+90 ;;CODE^6600^INLAY - PORCELAIN/CERAMIC, TWO SURFACES
+91 ;;SVC^9^65^V52.3
+92 ;;SYN^INLAY PORCELAIN/CERAMIC, 2-SFC
+93 ;;CODE^6601^INLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
+94 ;;SVC^9^70^V52.3
+95 ;;SYN^INLAY PORCELAIN/CERAMIC, 3+SFC
+96 ;;CODE^6602^INLAY - CAST HIGH NOBLE METAL, TWO SURFACES"
+97 ;;SVC^9^65^V52.3
+98 ;;SYN^INLAY - CAST HI NOBLE, 2-SFC
+99 ;;CODE^6603^INLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES
+100 ;;SVC^9^70^V52.3
+101 ;;SYN^INLAY - CAST HI NOBLE, 3+SFC
+102 ;;CODE^6604^INLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES
+103 ;;SVC^9^65^V52.3
+104 ;;SYN^INLAY - CAST BASE, 2-SFC
+105 ;;CODE^6605^INLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES
+106 ;;SVC^9^70^V52.3
+107 ;;SYN^INLAY - CAST BASE, 3+SFC
+108 ;;CODE^6606^INLAY - CAST NOBLE METAL, TWO SURFACES
+109 ;;SVC^9^65^V52.3
+110 ;;SYN^INLAY - CAST NOBLE, 2-SFC
+111 ;;CODE^6607^INLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
+112 ;;SVC^9^70^V52.3
+113 ;;SYN^INLAY - CAST NOBLE, 3+SFC
+114 ;;CODE^6608^ONLAY -PORCELAIN/CERAMIC, TWO SURFACES
+115 ;;SVC^9^65^V52.3
+116 ;;SYN^ONLAY - PORC/CER 2-SFC
+117 ;;CODE^6609^ONLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
+118 ;;SVC^9^70^V52.3
+119 ;;SYN^ONLAY - PORC/CER 3+SFC
+120 ;;CODE^6610^ONLAY - CAST HIGH NOBLE METAL, TWO SURFACES
+121 ;;SVC^9^65^V52.3
+122 ;;SYN^ONLAY - HI NOBLE 2-SFC
+123 ;;CODE^6611^ONLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES
+124 ;;SVC^9^70^V52.3
+125 ;;SYN^ONLAY - HI NOBLE 3+SFC
+126 ;;CODE^6612^ONLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES
+127 ;;SVC^9^65^V52.3
+128 ;;SYN^ONLAY - BASE 2-SFC
+129 ;;CODE^6613^ONLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES
+130 ;;SVC^9^70^V52.3
+131 ;;SYN^ONLAY - BASE 3+SFC
+132 ;;CODE^6614^ONLAY - CAST NOBLE METAL, TWO SURFACES
+133 ;;SVC^9^65^V52.3
+134 ;;SYN^ONLAY - NOBLE 2-SFC
+135 ;;CODE^6615^ONLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
+136 ;;SVC^9^70^V52.3
+137 ;;SYN^ONLAY - NOBLE 3+SFC
+138 ;;CODE^6793^PROVISIONAL RETAINER CROWN
+139 ;;SVC^5^115^V52.3
+140 ;;SYN^PROVISIONAL RETAINER CROWN
+141 ;;USE
+142 ;;Retainer crown utilized as an interim of at least six months duration during restorative treatment to allow adequate time for healing or completion of other procedures.
+143 ;;This is not to be used as a temporary retainer crown for routine prosthetic fixed partial dentures.
+144 ;;CODE^6985^PEDIATRIC PARTIAL DENTURE, FIXED
+145 ;;SVC^5^45^V52.3
+146 ;;SYN^PED PART DENT
+147 ;;CODE^7111^CORONAL REMNANTS - DECIDUOUS TOOTH
+148 ;;SVC^1^5^520.6
+149 ;;SYN^CORONAL REMNANTS
+150 ;;USE
+151 ;;Includes soft tissue-retained coronal remnants.
+152 ;;CODE^7140^EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL)
+153 ;;SVC^1^15^520.6
+154 ;;SYN^EXTRACTION
+155 ;;USE
+156 ;;Includes routine removal of tooth structure and closure, as necessary
+157 ;;CODE^7261^PRIMARY CLOSURE OF A SINUS PERFORATION
+158 ;;SVC^5^30^520.6
+159 ;;SYN^SINUS CLOSURE
+160 ;;USE
+161 ;;Subsequent to surgical removal of tooth, exposure of sinus requiring repair, or immediate closure of oroantral or oralnasal communication in absence of fistulus tract.
+162 ;;CODE^7282^MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION
+163 ;;SVC^5^60^520.6
+164 ;;SYN^MOBILIZATION
+165 ;;USE
+166 ;;To move/luxate teeth to eliminate ankyolosis; not in conjunction with an extraction.
+167 ;;CODE^7287^CYTOLOGY SAMPLE COLLECTION
+168 ;;SVC^1^5^520.6
+169 ;;SYN^CYTOLOGY
+170 ;;USE
+171 ;;For collection of oral cytology sample via mild scraping of the oral mucosa.
+172 ;;CODE^7411^EXCISION OF BENIGN LESION GREATER THAN 1.25 CM
+173 ;;SVC^3^35^520.6
+174 ;;SYN^EXCISION BENIGN LESION
+175 ;;CODE^7412^EXCISION OF BENIGN LESION, COMPLICATED
+176 ;;SVC^3^60^520.6
+177 ;;SYN^EXCISION BENIGN LESION COMPL
+178 ;;USE
+179 ;;Requires extensive undermining with advancement or rotational flap closure
+180 ;;CODE^7413^EXCISION OF MALIGNANT LESION UP TO 1.25 CM
+181 ;;SVC^3^25^520.6
+182 ;;SYN^EXCISION MALIGNANT LESION
+183 ;;CODE^7414^EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM
+184 ;;SVC^3^30^520.6
+185 ;;SYN^EXCISION MALIGNANT LESION > 1.25CM
+186 ;;CODE^7415^EXCISION OF MALIGNANT LESION, COMPLICATED
+187 ;;SVC^3^75^520.6
+188 ;;SYN^EXCISION MALIGNANT LESION COMPL
+189 ;;CODE^7472^REMOVAL OF TORUS PALATINUS
+190 ;;SVC^4^30^520.6
+191 ;;SYN^REMOVAL TORUS PALATINUS
+192 ;;CODE^7473^REMOVAL OF TORUS MANDIBULARIS
+193 ;;SVC^4^30^520.6
+194 ;;SYN^REMOVAL TORUS MANDIBULARIS
+195 ;;CODE^7485^SURGICAL REDUCTION OF OSSEOUS TUBEROSITY
+196 ;;SVC^4^20^520.6
+197 ;;SYN^SURGICAL REDUCTION OSSEOUS TUBEROSITY
+198 ;;CODE^7671^ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
+199 ;;SVC^1^180^520.6
+200 ;;SYN^ALVEOLUS - OPEN REDUCTION
+201 ;;USE
+202 ;;Teeth may be wired, banded or splinted together to prevent movement.
+203 ;;CODE^7771^ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH
+204 ;;SVC^1^120^520.6
+205 ;;SYN^ALVEOLUS, CLOSED REDUCTION
+206 ;;USE
+207 ;;Fractured bone(s) are exposed to mouth or outside the face.
+208 ;;CODE^7972^SURGICAL REDUCTION OF FIBROUS TUBEROSITY
+209 ;;SVC^4^20^520.6
+210 ;;SYN^SURGICAL REDUCTION FIBROUS TUBEROSITY
+211 ;;CODE^9450^CASE PRESENTATION, DETAILED AND EXTENSIVE TREATMENT PLANNING
+212 ;;SVC^3^15^521.0
+213 ;;SYN^CASE PRESENTATION
+214 ;;NOP
+215 ;;USE
+216 ;;Case presentation involves detailed and extensive treatment planning.
