ADECD471 ; IHS/SET/HMW - ADA CODE TABLE UPDATE (CDT4) ;
;;6.0;ADE;**14**;MAR 25, 1999
;
;;CODE^0150^COMPREHENSIVE ORAL EVALUATION - NEW OR ESTABLISHED PATIENT
;;SVC^3^15^V72.2
;;CODE^2140^AMALGAM - ONE SURFACE
;;SVC^3^12^521.0
;;CODE^2150^AMALGAM - TWO SURFACES
;;SVC^3^18^521.0
;;CODE^2160^AMALGAM - THREE SURFACES
;;SVC^3^22^521.0
;;CODE^2161^AMALGAM - FOUR OR MORE SURFACES
;;SVC^4^26^521.0
;;CODE^4210^GINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES PER QUADRANT
;;SVC^4^60^523.9
;;CODE^4211^GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE TEETH, PER QUADRANT
;;SVC^4^15^523.9
;;CODE^4240^GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES PER QUADRANT
;;SVC^4^60^523.9
;;CODE^4260^OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES PER QUADRANT
;;SVC^5^75^523.9
;;CODE^4341^PERIODONTAL SCALING AND ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES PER QUADRANT
;;SVC^3^30^523.9
;;CODE^7270^TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED TOOTH
;;SVC^1^45^520.6
;;CODE^7291^TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, BY REPORT
;;SVC^5^20^520.6
;;CODE^7410^EXCISION OF BENIGN LESION UP TO 1.25 CM
;;SVC^3^25^520.6
;;CODE^7450^REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM
;;SVC^3^35^520.6
;;CODE^7451^REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN 1.25 CM
;;SVC^3^35^520.6
;;CODE^7460^REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM
;;SVC^3^35^520.6
;;CODE^7461^REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN 1.25 CM
;;SVC^3^30^520.6
;;CODE^7471^REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE)
;;SVC^4^20^520.6
;;CODE^7530^REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE
;;SVC^3^25^520.6
;;CODE^7550^PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE
;;SVC^6^53^520.6
;;CODE^7670^ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
;;SVC^1^120^802.4
;;CODE^7770^ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH
;;SVC^1^180^802.4
;;CODE^0120^PERIODIC ORAL EVALUATION
;;SVC^3^10^V72.2
;;USE
;;An evaluation performed on a patient of record to determine any changes
;;in the patient's dental and medical health status since a previous comprehensive
;;or periodic evaluation. This includes periodontal screening and may require
;;interpretation of information acquired through additional diagnostic procedures.
;;Report additional diagnostic procedures separately.
;;CODE^0140^LIMITED ORAL EVALUATION - PROBLEM FOCUSED
;;SVC^1^5^V72.2
;;USE
;;An evaluation limited to a specific oral health problem or complaint. This may
;;require interpretation of information acquired through additional diagnostic procedures.
;;Report additional diagnostic procedures separately. Definitive procedures may be
;;required on the same date as the evaluation. Typically, patients receiving this type of
;;evaluation present with a specific problem and/or dental emergencies, trauma, acute infections, etc.
;;CODE^0277^VERTICAL BITEWINGS - 7 TO 8 FILMS
;;SVC^3^12^V72.2
;;USE
;;This does not constitute a full mouth intraoral radiographic series.
;;CODE^1110^PROPHYLAXIS - ADULT
;;SVC^2^40^V07.8
;;USE
;;A dental prophylaxis performed on transitional or permanent dentition that
;;includes scaling and/or polishing procedures to remove coronal plaque, calculus and stains.
;;CODE^2950^CORE BUILDUP, INCLUDING PINS
;;SVC^4^45^521.0
;;USE
;;Refers to building up of anatomical crown when restorative crown will be placed,
;;whether or not pins are used. A material is placed in the tooth preparation for a
;;crown when there is insufficient tooth strength and retention for the crown procedure.
;;This should not be reported when the procedure only involves a filler to eliminate any
;;undercut, box form, or concave irregularity in the preparation.
;;CODE^6056^PREFABRICATED ABUTMENT
;;SVC^6^20^V52.3
;;USE
;;A connection to an implant that is a manufactured component usually made of
;;machined high noble metal, titanium, titanium alloy or ceramic. Modification
;;of a prefabricated abutment may be necessary, and is accomplished by altering
;;its shape using dental burrs/diamonds.
;;CODE^6057^CUSTOM ABUTMENT
;;SVC^6^60^V52.3
;;USE
;;A connection to an implant that is a fabricated component, usually by a
;;laboratory, specific for an individual application. A custom abutment is
;;typically fabricated using a casting process and usually is made of noble or
;;high noble metal. A 'UCLA abutment' is an example of this type abutment.
;;CODE^7286^BIOPSY OF ORAL TISSUE - SOFT (ALL OTHERS)
;;SVC^3^20^520.6
;;USE
;;For surgical removal of specimen only. This code is not used at the same time
;;as codes for apicoectomy/periradicular curettage. For oral pathology procedures
;;see D0472, D0473, D0474 or D0502.
;;CODE^7290^SURGICAL REPOSITIONING OF TEETH
;;SVC^6^30^520.6
;;USE
;;Grafting procedure(s) is/are additional
;;CODE^7490^RADICAL RESECTION OF MANDIBLE W/ BONE GRAFT
;;SVC^6^180^520.6
;;USE
;;Partial resection of mandible; removal of lesion and defect with margin of
;;normal appearing bone. Reconstruction and bone grafts should be reported separately.
;;CODE^7510^INCISION & DRAINAGE OF ABSCESS - INTRAORAL
;;SVC^1^15^520.6
;;USE
;;Involves incision through mucosa, including periodontal origins.
;;CODE^7780^FACIAL BONES - COMPLICATED REDUCTION
;;SVC^1^180^802.4
;;USE
;;Surgical incision required to reduce fracture. Facial bones include upper and
;;lower jaw, cheek, and bones around eyes, nose, and ears.
;;CODE^9248^NON-INTRAVENOUS CONSCIOUS SEDATION
;;SVC^5^30^525.9
;;USE
;;A medically controlled state of depressed consciousness while maintaining the
;;patient's airway, protective reflexes and the ability to respond to stimulation or
;;verbal commands. It includes non-intravenous administration of sedative and/or
;;analgesic agent(s) and appropriate monitoring.
;;CODE^9310^CONSULTATION
;;SVC^6^30^525.9
;;USE
;;Type of service provided by a dentist or dental specialist whose opinion or
;;advice regarding evaluation and/or management of a specific problem may be
;;requested by another dentist, physician or appropriate source. The dentist
;;may initiate diagnostic and/or therapeutic services.
ADECD471 ; IHS/SET/HMW - ADA CODE TABLE UPDATE (CDT4) ;
+1 ;;6.0;ADE;**14**;MAR 25, 1999
+2 ;
+3 ;;CODE^0150^COMPREHENSIVE ORAL EVALUATION - NEW OR ESTABLISHED PATIENT
+4 ;;SVC^3^15^V72.2
+5 ;;CODE^2140^AMALGAM - ONE SURFACE
+6 ;;SVC^3^12^521.0
+7 ;;CODE^2150^AMALGAM - TWO SURFACES
+8 ;;SVC^3^18^521.0
+9 ;;CODE^2160^AMALGAM - THREE SURFACES
+10 ;;SVC^3^22^521.0
+11 ;;CODE^2161^AMALGAM - FOUR OR MORE SURFACES
+12 ;;SVC^4^26^521.0
+13 ;;CODE^4210^GINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES PER QUADRANT
+14 ;;SVC^4^60^523.9
+15 ;;CODE^4211^GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE TEETH, PER QUADRANT
+16 ;;SVC^4^15^523.9
+17 ;;CODE^4240^GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES PER QUADRANT
+18 ;;SVC^4^60^523.9
+19 ;;CODE^4260^OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES PER QUADRANT
+20 ;;SVC^5^75^523.9
+21 ;;CODE^4341^PERIODONTAL SCALING AND ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES PER QUADRANT
+22 ;;SVC^3^30^523.9
+23 ;;CODE^7270^TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED TOOTH
+24 ;;SVC^1^45^520.6
+25 ;;CODE^7291^TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, BY REPORT
+26 ;;SVC^5^20^520.6
+27 ;;CODE^7410^EXCISION OF BENIGN LESION UP TO 1.25 CM
+28 ;;SVC^3^25^520.6
+29 ;;CODE^7450^REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM
+30 ;;SVC^3^35^520.6
+31 ;;CODE^7451^REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN 1.25 CM
+32 ;;SVC^3^35^520.6
+33 ;;CODE^7460^REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM
+34 ;;SVC^3^35^520.6
+35 ;;CODE^7461^REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN 1.25 CM
+36 ;;SVC^3^30^520.6
+37 ;;CODE^7471^REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE)
+38 ;;SVC^4^20^520.6
+39 ;;CODE^7530^REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE
+40 ;;SVC^3^25^520.6
+41 ;;CODE^7550^PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE
+42 ;;SVC^6^53^520.6
+43 ;;CODE^7670^ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
+44 ;;SVC^1^120^802.4
+45 ;;CODE^7770^ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH
+46 ;;SVC^1^180^802.4
+47 ;;CODE^0120^PERIODIC ORAL EVALUATION
+48 ;;SVC^3^10^V72.2
+49 ;;USE
+50 ;;An evaluation performed on a patient of record to determine any changes
+51 ;;in the patient's dental and medical health status since a previous comprehensive
+52 ;;or periodic evaluation. This includes periodontal screening and may require
+53 ;;interpretation of information acquired through additional diagnostic procedures.
+54 ;;Report additional diagnostic procedures separately.
+55 ;;CODE^0140^LIMITED ORAL EVALUATION - PROBLEM FOCUSED
+56 ;;SVC^1^5^V72.2
+57 ;;USE
+58 ;;An evaluation limited to a specific oral health problem or complaint. This may
+59 ;;require interpretation of information acquired through additional diagnostic procedures.
+60 ;;Report additional diagnostic procedures separately. Definitive procedures may be
+61 ;;required on the same date as the evaluation. Typically, patients receiving this type of
+62 ;;evaluation present with a specific problem and/or dental emergencies, trauma, acute infections, etc.
+63 ;;CODE^0277^VERTICAL BITEWINGS - 7 TO 8 FILMS
+64 ;;SVC^3^12^V72.2
+65 ;;USE
+66 ;;This does not constitute a full mouth intraoral radiographic series.
+67 ;;CODE^1110^PROPHYLAXIS - ADULT
+68 ;;SVC^2^40^V07.8
+69 ;;USE
+70 ;;A dental prophylaxis performed on transitional or permanent dentition that
+71 ;;includes scaling and/or polishing procedures to remove coronal plaque, calculus and stains.
+72 ;;CODE^2950^CORE BUILDUP, INCLUDING PINS
+73 ;;SVC^4^45^521.0
+74 ;;USE
+75 ;;Refers to building up of anatomical crown when restorative crown will be placed,
+76 ;;whether or not pins are used. A material is placed in the tooth preparation for a
+77 ;;crown when there is insufficient tooth strength and retention for the crown procedure.
+78 ;;This should not be reported when the procedure only involves a filler to eliminate any
+79 ;;undercut, box form, or concave irregularity in the preparation.
+80 ;;CODE^6056^PREFABRICATED ABUTMENT
+81 ;;SVC^6^20^V52.3
+82 ;;USE
+83 ;;A connection to an implant that is a manufactured component usually made of
+84 ;;machined high noble metal, titanium, titanium alloy or ceramic. Modification
+85 ;;of a prefabricated abutment may be necessary, and is accomplished by altering
+86 ;;its shape using dental burrs/diamonds.
+87 ;;CODE^6057^CUSTOM ABUTMENT
+88 ;;SVC^6^60^V52.3
+89 ;;USE
+90 ;;A connection to an implant that is a fabricated component, usually by a
+91 ;;laboratory, specific for an individual application. A custom abutment is
+92 ;;typically fabricated using a casting process and usually is made of noble or
+93 ;;high noble metal. A 'UCLA abutment' is an example of this type abutment.
+94 ;;CODE^7286^BIOPSY OF ORAL TISSUE - SOFT (ALL OTHERS)
+95 ;;SVC^3^20^520.6
+96 ;;USE
+97 ;;For surgical removal of specimen only. This code is not used at the same time
+98 ;;as codes for apicoectomy/periradicular curettage. For oral pathology procedures
+99 ;;see D0472, D0473, D0474 or D0502.
+100 ;;CODE^7290^SURGICAL REPOSITIONING OF TEETH
+101 ;;SVC^6^30^520.6
+102 ;;USE
+103 ;;Grafting procedure(s) is/are additional
+104 ;;CODE^7490^RADICAL RESECTION OF MANDIBLE W/ BONE GRAFT
+105 ;;SVC^6^180^520.6
+106 ;;USE
+107 ;;Partial resection of mandible; removal of lesion and defect with margin of
+108 ;;normal appearing bone. Reconstruction and bone grafts should be reported separately.
+109 ;;CODE^7510^INCISION & DRAINAGE OF ABSCESS - INTRAORAL
+110 ;;SVC^1^15^520.6
+111 ;;USE
+112 ;;Involves incision through mucosa, including periodontal origins.
+113 ;;CODE^7780^FACIAL BONES - COMPLICATED REDUCTION
+114 ;;SVC^1^180^802.4
+115 ;;USE
+116 ;;Surgical incision required to reduce fracture. Facial bones include upper and
+117 ;;lower jaw, cheek, and bones around eyes, nose, and ears.
+118 ;;CODE^9248^NON-INTRAVENOUS CONSCIOUS SEDATION
+119 ;;SVC^5^30^525.9
+120 ;;USE
+121 ;;A medically controlled state of depressed consciousness while maintaining the
+122 ;;patient's airway, protective reflexes and the ability to respond to stimulation or
+123 ;;verbal commands. It includes non-intravenous administration of sedative and/or
+124 ;;analgesic agent(s) and appropriate monitoring.
+125 ;;CODE^9310^CONSULTATION
+126 ;;SVC^6^30^525.9
+127 ;;USE
+128 ;;Type of service provided by a dentist or dental specialist whose opinion or
+129 ;;advice regarding evaluation and/or management of a specific problem may be
+130 ;;requested by another dentist, physician or appropriate source. The dentist
+131 ;;may initiate diagnostic and/or therapeutic services.
