ADECDT2 ; IHS/HQT/MJL - ADA CODE TABLE UPDATE (CDT3) ;
;;6.0;ADE;**7**;APR 03, 2001
;
;;CODE^2642^ONLAY - PORCELAIN/CERAMIC - TWO SURFACES
;;SVC^^
;;USE
;;
;;CODE^2643^ONLAY - PORCELAIN/CERAMIC - THREE SURFACES
;;SVC^^
;;USE
;;
;;CODE^2644^ONLAY - PORCELAIN/CERAMIC - FOUR OR MORE SURFACES
;;SVC^^
;;USE
;;
;;CODE^2650^INLAY - RESIN-BASED COMPOSITE - ONE SURFACE
;;SVC^^
;;USE
;;
;;CODE^2651^INLAY - RESIN-BASED COMPOSITE - TWO SURFACES
;;SVC^^
;;USE
;;
;;CODE^2652^INLAY - RESIN-BASED COMPOSITE - THREE OR MORE SURFACES
;;SVC^^
;;USE
;;
;;CODE^2662^ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES
;;SVC^^
;;USE
;;
;;CODE^2663^ONLAY - RESIN-BASED COMPOSITE - THREE SURFACES
;;SVC^^
;;USE
;;
;;CODE^2664^ONLAY - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES
;;SVC^^
;;USE
;;
;;CODE^2780^CROWN - 3/4 CAST HIGH NOBLE METAL
;;MNE^CNH
;;SVC^4^115^9148
;;SYN^CRN 3/4 HIGH
;;USE
;;
;;CODE^2781^CROWN - 3/4 CAST PREDOMINATELY BASE METAL
;;MNE^CNB
;;SVC^4^115^9148
;;SYN^CRN 3/4 BASE
;;USE
;;
;;CODE^2782^CROWN - 3/4 CAST NOBLE METAL
;;MNE^CNN
;;SVC^4^115^9148
;;SYN^CRN 3/4 NOBLE
;;USE
;;
;;CODE^2783^CROWN - 3/4 PORCELAIN/CERAMIC
;;MNE^CNP
;;SVC^4^115^9148
;;SYN^CRN 3/4 PORC
;;USE
;;This code does not include facial veneers.
;;CODE^2799^PROVISIONAL CROWN
;;MNE^CP
;;SVC^9^30^9148
;;SYN^PROV CRN
;;USE
;;Crown utilized as an interim restoration of at least six months duration during restorative treatment to allow adequate time for healing or completion of other procedures. This includes, but is not limited to, changing vertical dimension, completing
;;periodontal therapy or cracked tooth syndrome. This is not to be used as a temporary crown for a routine prosthetic restoration.
;;CODE^2940^SEDATIVE FILLING
;;SVC^^
;;USE
;;Temporary restoration intended to relieve pain. Not to be used as a base or liner under a restoration.
;;CODE^2952^CAST POST AND CORE IN ADDITION TO CROWN
;;SVC^^
;;USE
;;Cast post and core is separate from crown.
;;CODE^2953^EACH ADDITIONAL CAST POST - SAME TOOTH
;;MNE^ACP
;;SVC^4^10^9148
;;SYN^ADD CAST POST
;;USE
;;To be used with D2952
;;CODE^2957^EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH
;;MNE^APP
;;SVC^4^45^9148
;;SYN^ADD PREFAB POST
;;USE
;;To be used with D2954
;;CODE^2960^LABIAL VENEER (RESIN LAMINATE) - CHAIRSIDE
;;SVC^^
;;USE
;;Refers to labial/facial direct resin bonded veneers.
;;CODE^2961^LABIAL VENEER (RESIN LAMINATE) - LABORATORY
;;SVC^^
;;USE
;;Refers to labial/facial indirect resin bonded veneers.
;;CODE^2962^LABIAL VENEER (PORCELAIN LAMINATE) - LABORATORY
;;SVC^^
;;USE
;;Refers also to facial veneers that extend interproximally and/or cover the incisal edge. Porcelain/ceramic veneers presently include all ceramic, porcelain, and polymer-reinforced porcelain veneers.
;;CODE^3220^THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT.
;;SVC^^
;;USE
;;Pulpotomy is the surgical removal of a portion of the pulp with the aim of maintaining the vitality of the remaining portion by means of an adequate dressing. It is to be performed on primary or permanent teeth. This is not to be construed as the first
;;stage of root canal therapy.
;;CODE^3221^GROSS PULPAL DEBRIDEMENT, ALL TEETH.
;;MNE^GPD
;;SVC^1^20^2834
;;SYN^GROSS PULP DEB
;;USE
;;Gross pulpal debridement for the relief of acute pain prior to conventional root canal therapy (not to be used by provider completing endodontic treatment).
;;CODE^3331^TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS
;;MNE^RCO
;;SVC^5^30^2834
;;SYN^RCT OBST NS
;;USE
;;In lieu of surgery, the formation of a pathway to achieve an apical seal without surgical intervention because of a non-negotiable root canal blocked by foreign bodies or calcification of 50% or more of root.
;;CODE^3332^INCOMPLETE ENDODONTIC THERAPY; INOPERABLE OR FRACTURED TOOTH
;;MNE^ICE
;;SVC^4^15^2834
;;SYN^INCOMP ENDO
;;USE
;;Considerable time is necessary to determine diagnosis and/or provide initial treatment before the fracture makes the tooth unretainable.
;;CODE^3333^INTERNAL ROOT REPAIR OF PERFORATION DEFECTS
;;MNE^IRR
;;SVC^5^30^2834
;;SYN^INT ROOT REP
;;USE
;;Non-surgical seal of perforation caused by resorption and/or decay but not iatrogenic by provider filing claim.
;;CODE^4245^APICALLY POSITIONED FLAP
;;MNE^APF
;;SVC^5^45^2842
;;SYN^APIC POS FLAP
;;USE
;;Procedure is used to preserve keratinized gingiva in conjunction with osseous resection and second stage implant procedure. Procedure may also be used to preserve keratinized/attached gingiva during surgical exposure of labially impacted teeth, and may
;;be used during treatment of peri-implantitis.
;;CODE^4249^CLINICAL CROWN LENGTHENING - HARD TISSUE
;;SVC^^
;;USE
;;This procedure is employed to allow restorative procedure or crown with little or no tooth structure exposed to the oral cavity. Crown lengthening requires reflection of a flap and is performed in a healthy periodontal environment, as opposed to osseous
;;surgery which is performed in the presence of periodontal disease. Where there are adjacent teeth, the flap design may involve a larger surgical area.
ADECDT2 ; IHS/HQT/MJL - ADA CODE TABLE UPDATE (CDT3) ;
+1 ;;6.0;ADE;**7**;APR 03, 2001
+2 ;
+3 ;;CODE^2642^ONLAY - PORCELAIN/CERAMIC - TWO SURFACES
+4 ;;SVC^^
+5 ;;USE
+6 ;;
+7 ;;CODE^2643^ONLAY - PORCELAIN/CERAMIC - THREE SURFACES
+8 ;;SVC^^
+9 ;;USE
+10 ;;
+11 ;;CODE^2644^ONLAY - PORCELAIN/CERAMIC - FOUR OR MORE SURFACES
+12 ;;SVC^^
+13 ;;USE
+14 ;;
+15 ;;CODE^2650^INLAY - RESIN-BASED COMPOSITE - ONE SURFACE
+16 ;;SVC^^
+17 ;;USE
+18 ;;
+19 ;;CODE^2651^INLAY - RESIN-BASED COMPOSITE - TWO SURFACES
+20 ;;SVC^^
+21 ;;USE
+22 ;;
+23 ;;CODE^2652^INLAY - RESIN-BASED COMPOSITE - THREE OR MORE SURFACES
+24 ;;SVC^^
+25 ;;USE
+26 ;;
+27 ;;CODE^2662^ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES
+28 ;;SVC^^
+29 ;;USE
+30 ;;
+31 ;;CODE^2663^ONLAY - RESIN-BASED COMPOSITE - THREE SURFACES
+32 ;;SVC^^
+33 ;;USE
+34 ;;
+35 ;;CODE^2664^ONLAY - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES
+36 ;;SVC^^
+37 ;;USE
+38 ;;
+39 ;;CODE^2780^CROWN - 3/4 CAST HIGH NOBLE METAL
+40 ;;MNE^CNH
+41 ;;SVC^4^115^9148
+42 ;;SYN^CRN 3/4 HIGH
+43 ;;USE
+44 ;;
+45 ;;CODE^2781^CROWN - 3/4 CAST PREDOMINATELY BASE METAL
+46 ;;MNE^CNB
+47 ;;SVC^4^115^9148
+48 ;;SYN^CRN 3/4 BASE
+49 ;;USE
+50 ;;
+51 ;;CODE^2782^CROWN - 3/4 CAST NOBLE METAL
+52 ;;MNE^CNN
+53 ;;SVC^4^115^9148
+54 ;;SYN^CRN 3/4 NOBLE
+55 ;;USE
+56 ;;
+57 ;;CODE^2783^CROWN - 3/4 PORCELAIN/CERAMIC
+58 ;;MNE^CNP
+59 ;;SVC^4^115^9148
+60 ;;SYN^CRN 3/4 PORC
+61 ;;USE
+62 ;;This code does not include facial veneers.
+63 ;;CODE^2799^PROVISIONAL CROWN
+64 ;;MNE^CP
+65 ;;SVC^9^30^9148
+66 ;;SYN^PROV CRN
+67 ;;USE
+68 ;;Crown utilized as an interim restoration of at least six months duration during restorative treatment to allow adequate time for healing or completion of other procedures. This includes, but is not limited to, changing vertical dimension, comp
leting
+69 ;;periodontal therapy or cracked tooth syndrome. This is not to be used as a temporary crown for a routine prosthetic restoration.
+70 ;;CODE^2940^SEDATIVE FILLING
+71 ;;SVC^^
+72 ;;USE
+73 ;;Temporary restoration intended to relieve pain. Not to be used as a base or liner under a restoration.
+74 ;;CODE^2952^CAST POST AND CORE IN ADDITION TO CROWN
+75 ;;SVC^^
+76 ;;USE
+77 ;;Cast post and core is separate from crown.
+78 ;;CODE^2953^EACH ADDITIONAL CAST POST - SAME TOOTH
+79 ;;MNE^ACP
+80 ;;SVC^4^10^9148
+81 ;;SYN^ADD CAST POST
+82 ;;USE
+83 ;;To be used with D2952
+84 ;;CODE^2957^EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH
+85 ;;MNE^APP
+86 ;;SVC^4^45^9148
+87 ;;SYN^ADD PREFAB POST
+88 ;;USE
+89 ;;To be used with D2954
+90 ;;CODE^2960^LABIAL VENEER (RESIN LAMINATE) - CHAIRSIDE
+91 ;;SVC^^
+92 ;;USE
+93 ;;Refers to labial/facial direct resin bonded veneers.
+94 ;;CODE^2961^LABIAL VENEER (RESIN LAMINATE) - LABORATORY
+95 ;;SVC^^
+96 ;;USE
+97 ;;Refers to labial/facial indirect resin bonded veneers.
+98 ;;CODE^2962^LABIAL VENEER (PORCELAIN LAMINATE) - LABORATORY
+99 ;;SVC^^
+100 ;;USE
+101 ;;Refers also to facial veneers that extend interproximally and/or cover the incisal edge. Porcelain/ceramic veneers presently include all ceramic, porcelain, and polymer-reinforced porcelain veneers.
+102 ;;CODE^3220^THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) REMOVAL OF PULP CORONAL TO THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT.
+103 ;;SVC^^
+104 ;;USE
+105 ;;Pulpotomy is the surgical removal of a portion of the pulp with the aim of maintaining the vitality of the remaining portion by means of an adequate dressing. It is to be performed on primary or permanent teeth. This is not to be construed a
s the first
+106 ;;stage of root canal therapy.
+107 ;;CODE^3221^GROSS PULPAL DEBRIDEMENT, ALL TEETH.
+108 ;;MNE^GPD
+109 ;;SVC^1^20^2834
+110 ;;SYN^GROSS PULP DEB
+111 ;;USE
+112 ;;Gross pulpal debridement for the relief of acute pain prior to conventional root canal therapy (not to be used by provider completing endodontic treatment).
+113 ;;CODE^3331^TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS
+114 ;;MNE^RCO
+115 ;;SVC^5^30^2834
+116 ;;SYN^RCT OBST NS
+117 ;;USE
+118 ;;In lieu of surgery, the formation of a pathway to achieve an apical seal without surgical intervention because of a non-negotiable root canal blocked by foreign bodies or calcification of 50% or more of root.
+119 ;;CODE^3332^INCOMPLETE ENDODONTIC THERAPY; INOPERABLE OR FRACTURED TOOTH
+120 ;;MNE^ICE
+121 ;;SVC^4^15^2834
+122 ;;SYN^INCOMP ENDO
+123 ;;USE
+124 ;;Considerable time is necessary to determine diagnosis and/or provide initial treatment before the fracture makes the tooth unretainable.
+125 ;;CODE^3333^INTERNAL ROOT REPAIR OF PERFORATION DEFECTS
+126 ;;MNE^IRR
+127 ;;SVC^5^30^2834
+128 ;;SYN^INT ROOT REP
+129 ;;USE
+130 ;;Non-surgical seal of perforation caused by resorption and/or decay but not iatrogenic by provider filing claim.
+131 ;;CODE^4245^APICALLY POSITIONED FLAP
+132 ;;MNE^APF
+133 ;;SVC^5^45^2842
+134 ;;SYN^APIC POS FLAP
+135 ;;USE
+136 ;;Procedure is used to preserve keratinized gingiva in conjunction with osseous resection and second stage implant procedure. Procedure may also be used to preserve keratinized/attached gingiva during surgical exposure of labially impacted teet
h, and may
+137 ;;be used during treatment of peri-implantitis.
+138 ;;CODE^4249^CLINICAL CROWN LENGTHENING - HARD TISSUE
+139 ;;SVC^^
+140 ;;USE
+141 ;;This procedure is employed to allow restorative procedure or crown with little or no tooth structure exposed to the oral cavity. Crown lengthening requires reflection of a flap and is performed in a healthy periodontal environment, as opposed
to osseous
+142 ;;surgery which is performed in the presence of periodontal disease. Where there are adjacent teeth, the flap design may involve a larger surgical area.
