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Routine: ADECD41

ADECD41.m

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  1. ADECD41 ; IHS/SET/HMW - ADA CODE TABLE UPDATE (CDT4) ;
  1.  ;;6.0;ADE;**12**;MAR 25, 1999
  1.  ;
  1.  ;;CODE^0180^COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT
  1.  ;;SVC^4^45^V07.8
  1.  ;;SYN^PERIO EVAL
  1.  ;;NOP
  1.  ;;USE
  1.  ;;This procedure is indicated for patients showing signs or symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes.
  1.  ;;It includes evaluation of periodontal conditions, probing and charting, evaluation and recording of the patient's dental and medical history and general health assessment.
  1.  ;;It may include the evaluation and recording of dental caries, missing or unerupted teeth, restorations, occlusal relationships and oral cancer screening.
  1.  ;;CODE^2390^RESIN-BASED COMPOSITE CROWN, ANTERIOR
  1.  ;;SVC^4^35^521.0
  1.  ;;SYN^RESIN CROWN ANT
  1.  ;;USE
  1.  ;;Full resin-based composite coverage of tooth.
  1.  ;;CODE^2391^RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR
  1.  ;;SVC^3^15^521.0
  1.  ;;SYN^RESIN 1S POST
  1.  ;;USE
  1.  ;;Used to restore a carious lesion into the dentin or a deeply eroded area into the dentin.  Not a preventive procedure.
  1.  ;;Full resin-based composite coverage of tooth.
  1.  ;;CODE^2392^RESIN-BASED COMPOSITE - TWO SURFACE, POSTERIOR
  1.  ;;SVC^9^20^521.0
  1.  ;;SYN^RESIN 2S POST
  1.  ;;CODE^2393^RESIN-BASED COMPOSITE - THREE SURFACE, POSTERIOR
  1.  ;;SVC^9^30^521.0
  1.  ;;SYN^RESIN 3S POST
  1.  ;;CODE^2394^RESIN-BASED COMPOSITE - FOUR SURFACE, POSTERIOR
  1.  ;;SVC^9^30^521.0
  1.  ;;SYN^RESIN 4S POST
  1.  ;;CODE^4241^GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT
  1.  ;;SVC^4^40^523.9
  1.  ;;SYN^GINGIVAL FLAP
  1.  ;;USE
  1.  ;;Surgical debridement of the root surface and the removal of granulation tissue following the resection or reflection of soft tissue flap.
  1.  ;;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,
  1.  ;;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,
  1.  ;;and need for increased access to the root surface and alveolar bone.
  1.  ;;CODE^4261^OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - ONE TO THREE TEETH, PER QUADRANT
  1.  ;;MNE^OSSEOUS SURGERY
  1.  ;;SVC^5^50^523.9
  1.  ;;SYN^OSSEOUS SURG
  1.  ;;USE
  1.  ;;This procedure modifies the bony support of the teeth by reshaping the alveolar process to achieve a more physiologic form.
  1.  ;;This may include the removal of supporting bone (ostectomy) or non-supporting bone.
  1.  ;;Other separate procedures including, but not limited to, D3450, D3920, D4263, D4264, D4266, D4267, D6010 and D7140 may be required concurrent to D4260.
  1.  ;;CODE^4265^BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION
  1.  ;;SVC^5^15^523.9
  1.  ;;SYN^BIOLOGIC MATERIALS
  1.  ;;USE
  1.  ;;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.
  1.  ;;Does not include surgical entry and closure, wound debridement, osseous contouring, or the placement of graft materials and/or barrier membranes.
  1.  ;;CODE^4275^SOFT TISSUE ALLOGRAFT
  1.  ;;SVC^5^60^523.9
  1.  ;;SYN^SOFT ALLOGRAFT
  1.  ;;USE
  1.  ;;Procedure is performed to create or augment the gingiva, with or without root coverage.
  1.  ;;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.
  1.  ;;CODE^4276^COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT
  1.  ;;SVC^5^60^523.9
  1.  ;;SYN^CONN TISS GRAFT
  1.  ;;USE
  1.  ;;Advanced gingival recession often cannot be corrected with a single procedure.  Combined tissue grafting procedures are needed to achieve the desired outcome.
  1.  ;;CODE^4342^PERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT
  1.  ;;SVC^3^20^523.9
  1.  ;;SYN^ROOT PLANE/QUAD
  1.  ;;USE
  1.  ;;This procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces.
  1.  ;;It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature.
  1.  ;;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.
  1.  ;;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.
  1.  ;;CODE^5670^REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MAXILLARY) 
  1.  ;;SVC^5^60^525.1
  1.  ;;SYN^REPLACE TEETH ACRYL (MAX)
  1.  ;;CODE^5671^REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MANDIBULAR)
  1.  ;;SVC^5^60^525.1
  1.  ;;SYN^REPLACE TEETH ACRYL (MAND)
  1.  ;;CODE^6053^IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR COMPLETELY EDENTULOUS ARCH
  1.  ;;SVC^5^160^V52.3
  1.  ;;SYN^IMPLANT/ABUTMENT DENTURE EDENT
  1.  ;;CODE^6054^IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH
  1.  ;;SVC^5^160^V52.3
  1.  ;;SYN^IMPLANT/ABUTMENT DENTURE PART EDENT
  1.  ;;CODE^6253^PROVISIONAL PONTIC
  1.  ;;SVC^5^0^V52.3
  1.  ;;SYN^PROVISIONAL PONTIC
  1.  ;;USE
  1.  ;;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.
  1.  ;;This is not to be used as a temporary pontic for routine prosthetic fixed partial dentures.
  1.  ;;CODE^6600^INLAY - PORCELAIN/CERAMIC, TWO SURFACES
  1.  ;;SVC^9^65^V52.3
  1.  ;;SYN^INLAY PORCELAIN/CERAMIC, 2-SFC
  1.  ;;CODE^6601^INLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
  1.  ;;SVC^9^70^V52.3
  1.  ;;SYN^INLAY PORCELAIN/CERAMIC, 3+SFC
  1.  ;;CODE^6602^INLAY - CAST HIGH NOBLE METAL, TWO SURFACES"
  1.  ;;SVC^9^65^V52.3
  1.  ;;SYN^INLAY - CAST HI NOBLE, 2-SFC
  1.  ;;CODE^6603^INLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES
  1.  ;;SVC^9^70^V52.3
  1.  ;;SYN^INLAY - CAST HI NOBLE, 3+SFC
  1.  ;;CODE^6604^INLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES
  1.  ;;SVC^9^65^V52.3
  1.  ;;SYN^INLAY - CAST BASE, 2-SFC
  1.  ;;CODE^6605^INLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES
  1.  ;;SVC^9^70^V52.3
  1.  ;;SYN^INLAY - CAST BASE, 3+SFC
  1.  ;;CODE^6606^INLAY - CAST NOBLE METAL, TWO SURFACES
  1.  ;;SVC^9^65^V52.3
  1.  ;;SYN^INLAY - CAST NOBLE, 2-SFC
  1.  ;;CODE^6607^INLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
  1.  ;;SVC^9^70^V52.3
  1.  ;;SYN^INLAY - CAST NOBLE, 3+SFC
  1.  ;;CODE^6608^ONLAY -PORCELAIN/CERAMIC, TWO SURFACES
  1.  ;;SVC^9^65^V52.3
  1.  ;;SYN^ONLAY - PORC/CER 2-SFC
  1.  ;;CODE^6609^ONLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
  1.  ;;SVC^9^70^V52.3
  1.  ;;SYN^ONLAY - PORC/CER 3+SFC
  1.  ;;CODE^6610^ONLAY - CAST HIGH NOBLE METAL, TWO SURFACES
  1.  ;;SVC^9^65^V52.3
  1.  ;;SYN^ONLAY - HI NOBLE 2-SFC
  1.  ;;CODE^6611^ONLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES
  1.  ;;SVC^9^70^V52.3
  1.  ;;SYN^ONLAY - HI NOBLE 3+SFC
  1.  ;;CODE^6612^ONLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES
  1.  ;;SVC^9^65^V52.3
  1.  ;;SYN^ONLAY - BASE 2-SFC
  1.  ;;CODE^6613^ONLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES
  1.  ;;SVC^9^70^V52.3
  1.  ;;SYN^ONLAY - BASE 3+SFC
  1.  ;;CODE^6614^ONLAY - CAST NOBLE METAL, TWO SURFACES
  1.  ;;SVC^9^65^V52.3
  1.  ;;SYN^ONLAY - NOBLE 2-SFC
  1.  ;;CODE^6615^ONLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
  1.  ;;SVC^9^70^V52.3
  1.  ;;SYN^ONLAY - NOBLE 3+SFC
  1.  ;;CODE^6793^PROVISIONAL RETAINER CROWN
  1.  ;;SVC^5^115^V52.3
  1.  ;;SYN^PROVISIONAL RETAINER CROWN
  1.  ;;USE
  1.  ;;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.
  1.  ;;This is not to be used as a temporary retainer crown for routine prosthetic fixed partial dentures.
  1.  ;;CODE^6985^PEDIATRIC PARTIAL DENTURE, FIXED
  1.  ;;SVC^5^45^V52.3
  1.  ;;SYN^PED PART DENT
  1.  ;;CODE^7111^CORONAL REMNANTS - DECIDUOUS TOOTH
  1.  ;;SVC^1^5^520.6
  1.  ;;SYN^CORONAL REMNANTS
  1.  ;;USE
  1.  ;;Includes soft tissue-retained coronal remnants.
  1.  ;;CODE^7140^EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL)
  1.  ;;SVC^1^15^520.6
  1.  ;;SYN^EXTRACTION
  1.  ;;USE
  1.  ;;Includes routine removal of tooth structure and closure, as necessary
  1.  ;;CODE^7261^PRIMARY CLOSURE OF A SINUS PERFORATION
  1.  ;;SVC^5^30^520.6
  1.  ;;SYN^SINUS CLOSURE
  1.  ;;USE
  1.  ;;Subsequent to surgical removal of tooth, exposure of sinus requiring repair, or immediate closure of oroantral or oralnasal communication in absence of fistulus tract.
  1.  ;;CODE^7282^MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION
  1.  ;;SVC^5^60^520.6
  1.  ;;SYN^MOBILIZATION
  1.  ;;USE
  1.  ;;To move/luxate teeth to eliminate ankyolosis; not in conjunction with an extraction.
  1.  ;;CODE^7287^CYTOLOGY SAMPLE COLLECTION
  1.  ;;SVC^1^5^520.6
  1.  ;;SYN^CYTOLOGY
  1.  ;;USE
  1.  ;;For collection of oral cytology sample via mild scraping of the oral mucosa. 
  1.  ;;CODE^7411^EXCISION OF BENIGN LESION GREATER THAN 1.25 CM
  1.  ;;SVC^3^35^520.6
  1.  ;;SYN^EXCISION BENIGN LESION
  1.  ;;CODE^7412^EXCISION OF BENIGN LESION, COMPLICATED 
  1.  ;;SVC^3^60^520.6
  1.  ;;SYN^EXCISION BENIGN LESION COMPL
  1.  ;;USE
  1.  ;;Requires extensive undermining with advancement or rotational flap closure
  1.  ;;CODE^7413^EXCISION OF MALIGNANT LESION UP TO 1.25 CM
  1.  ;;SVC^3^25^520.6
  1.  ;;SYN^EXCISION MALIGNANT LESION
  1.  ;;CODE^7414^EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM
  1.  ;;SVC^3^30^520.6
  1.  ;;SYN^EXCISION MALIGNANT LESION > 1.25CM
  1.  ;;CODE^7415^EXCISION OF MALIGNANT LESION, COMPLICATED
  1.  ;;SVC^3^75^520.6
  1.  ;;SYN^EXCISION MALIGNANT LESION COMPL
  1.  ;;CODE^7472^REMOVAL OF TORUS PALATINUS
  1.  ;;SVC^4^30^520.6
  1.  ;;SYN^REMOVAL TORUS PALATINUS
  1.  ;;CODE^7473^REMOVAL OF TORUS MANDIBULARIS
  1.  ;;SVC^4^30^520.6
  1.  ;;SYN^REMOVAL TORUS MANDIBULARIS
  1.  ;;CODE^7485^SURGICAL REDUCTION OF OSSEOUS TUBEROSITY
  1.  ;;SVC^4^20^520.6
  1.  ;;SYN^SURGICAL REDUCTION OSSEOUS TUBEROSITY
  1.  ;;CODE^7671^ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
  1.  ;;SVC^1^180^520.6
  1.  ;;SYN^ALVEOLUS - OPEN REDUCTION
  1.  ;;USE
  1.  ;;Teeth may be wired, banded or splinted together to prevent movement.
  1.  ;;CODE^7771^ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH
  1.  ;;SVC^1^120^520.6
  1.  ;;SYN^ALVEOLUS, CLOSED REDUCTION
  1.  ;;USE
  1.  ;;Fractured bone(s) are exposed to mouth or outside the face. 
  1.  ;;CODE^7972^SURGICAL REDUCTION OF FIBROUS TUBEROSITY
  1.  ;;SVC^4^20^520.6
  1.  ;;SYN^SURGICAL REDUCTION FIBROUS TUBEROSITY
  1.  ;;CODE^9450^CASE PRESENTATION, DETAILED AND EXTENSIVE TREATMENT PLANNING
  1.  ;;SVC^3^15^521.0
  1.  ;;SYN^CASE PRESENTATION
  1.  ;;NOP
  1.  ;;USE
  1.  ;;Case presentation involves detailed and extensive treatment planning.