- 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.