Diagnostic/ Adjunctive Services
D0999
Unspecified diagnostic procedure, by report
D1206
Topical application of fluoride varnish
D2140
Amalgam – one surface, permanent or primary
Codes under Endodontics Procedure
D3000-3999
D4255
Full mouth debridement
D0708
Intraoral – bitewing radiographic image – image capture only Image axis may be horizontal or vertical.
Prophylaxis Adult
D1110
Prefabricated resin crown
D2932
It includes exams, pulp tests, pulpotomy, pulpectomy, extirpation of pulp, and pre-operative, operative, and post-operative radiographs/diagnostic images, filling of canals, bacteriologic cultures, and local anesthesia.
ENDODONTIC PROCEDURES
CDT Code for Periodontal Maintenance
D4910
D0702
2-D cephalometric radiographic image – image capture only
Sealant – per tooth
D1351
Inlay – metallic, one surface
D2510
Pulp cap- Direct (excluding restoration)
D3110
D4264
Bone replacement graft-retained natural tooth- each additional site in quadrant
Occlusal analysis
D1353
Sealant repair – per toot
D2712
Crown - ¾ resin-based composite (indirect) does not include facial veneers
D3110
Pulp cap- Direct (excluding restoration)
True of False: Local anesthesia is usually considered to be part of Periodontal procedures
TRUE
D0478
Immunohistochemical stains
Distal shoe space maintainer- fixed, unilateral
D1575
D2910
Re-cement or re-bond inlay, onlay, veneer or partial coverage restoration
Submission requirements for participating providers for D3100
TOOTH IDENTIFICATION
Guidelines/ Frequency limitation for D4245 under Group Choice Copayment PPO
NOT A COVERED BENEFIT