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VIII. IMPLANT SERVICES


D6010

Surgical placement of implant body: endosteal implant

$

D6011

Second stage implant surgery

$

D6012

Surgical placement of interim implant body for transitional prosthesis: endosteal implant

$

D6013

Surgical placement of mini implant

$

D6040

Surgical placement: eposteal implant

$

D6050

Surgical placement: transosteal implant

$

D6051

Interim abutment

$

D6052

Semi – precision attachment abutment

$

D6055

Connecting bar – implant supported or abutment supported

$

D6056

Prefabricated abutment – includes modification and placement

$

D6057

Custom fabricated abutment – includes placement

$

D6058

Abutment supported porcelain/ceramic crown

$

D6059

Abutment supported porcelain fused to metal crown (high noble metal)

$

D6060

Abutment supported porcelain fused to metal crown (predominantly base metal)

$

D6061

Abutment supported porcelain fused to metal crown (noble metal)

$

D6062

Abutment supported cast metal crown (high noble metal)

$

D6063

Abutment supported cast metal crown (predominantly base metal)

$

D6064

Abutment supported cast metal crown (noble metal)

$

D6065

Implant supported porcelain/ceramic crown

$

D6066

Implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal)

$

D6067

Implant supported metal crown (titanium, titanium alloy, high noble metal)

$

D6068

Abutment supported retainer for porcelain/ceramic FPD

$

D6069

Abutment supported retainer for porcelain fused to metal FPD (high noble metal)

$

D6070

Abutment supported retainer for porcelain fused to metal FPD (predominantly base metal)

$

D6071

Abutment supported retainer for porcelain fused to metal FPD (noble metal)

$

D6072

Abutment supported retainer for cast metal FPD (high noble metal)

$

D6073

Abutment supported retainer for cast metal FPD (predominantly base metal)

$

D6074

Abutment supported retainer for cast metal FPD (noble metal)

$

D6075

Implant supported retainer for ceramic FPD

$

D6076

Implant supported retainer for porcelain fused to metal FPD (titanium, titanium alloy, or high noble metal)

$

D6077

Implant supported retainer for cast metal FPD (titanium, titanium alloy, or high noble metal)

$

D6080

Implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prosthesis and abutments

$

D6090

Repair implant supported prosthesis, by report

$

D6091

Replacement of semi-precision or precision attachment (male or female component) of implant/abutment supported prosthesis, per attachment

$


D6092

Re–cement or re–bond implant/abutment supported crown

$

D6093

Re–cement or re–bond implant/abutment supported fixed partial denture

$

D6094

Abutment supported crown (titanium)

$

D6095

Repair implant abutment, by report

$

D6100

Implant removal, by report

$

D6101

Debridement of a peri–implant defect or defects surrounding a single implant, and surface cleaning of the exposed implant surfaces, including flap entry and closure

$

D6102

Debridement and osseous contouring of a peri–implant defect or defects surrounding a single implant and includes surface cleaning of the exposed implant surfaces, including flap entry and closure

$

D6103

Bone graft for repair of peri–implant defect – does not include flap entry and closure

$

D6104

Bone graft at time of implant placement

$

D6110

Implant /abutment supported removable denture for edentulous arch – maxillary

$

D6111

Implant /abutment supported removable denture for edentulous arch – mandibular

$

D6112

Implant /abutment supported removable denture for partially edentulous arch – maxillary

$

D6113

Implant /abutment supported removable denture for partially edentulous arch – mandibular

$

D6114

Implant /abutment supported fixed denture for edentulous arch – maxillary

$

D6115

Implant /abutment supported fixed denture for edentulous arch – mandibular

$

D6116

Implant /abutment supported fixed denture for partially edentulous arch – maxillary

$

D6117

Implant /abutment supported fixed denture for partially edentulous arch – mandibular

$

D6190

Radiographic/surgical implant index, by report

$

D6194

Abutment supported retainer crown for FPD (titanium)

$

D6199

Unspecified implant procedure, by report

$

IX. PROSTHODONTICS, FIXED

D6205

Pontic – indirect resin based composite

$

D6210

Pontic – cast high noble metal

$

D6211

Pontic – cast predominantly base metal

$

D6212

Pontic – cast noble metal

$

D6214

Pontic – titanium

$

D6240

Pontic – porcelain fused to high noble metal

$

D6241

Pontic – porcelain fused to predominantly base metal

$

D6242

Pontic – porcelain fused to noble metal

$

D6245

Pontic – porcelain/ceramic

$

D6250

Pontic – resin with high noble metal

$

D6251

Pontic – resin with predominantly base metal

$

D6252

Pontic – resin with noble metal

$

D6253

Provisional pontic– further treatment or completion of diagnosis necessary prior to final impression

$

D6545

Retainer – cast metal for resin bonded fixed prosthesis

$

D6548

Retainer – porcelain/ceramic for resin bonded fixed prosthesis

$

D6549

Resin retainer – for resin bonded fixed prosthesis

$

D6600

Retainer Inlay – porcelain/ceramic, two surfaces

$

D6601

Retainer Inlay – porcelain/ceramic, three or more surfaces

$

D6602

Retainer Inlay – cast high noble metal, two surfaces

$

D6603

Retainer Inlay – cast high noble metal, three or more surfaces

$

D6604

Retainer Inlay – cast predominantly base metal, two surfaces

$

D6605

Retainer Inlay – cast predominantly base metal, three or more surfaces

$

D6606

Retainer Inlay – cast noble metal, two surfaces

$

D6607

Retainer Inlay – cast noble metal, three or more surfaces

$

D6608

Retainer Onlay – porcelain/ceramic, two surfaces

$

D6609

Retainer Onlay – porcelain/ceramic, three or more surfaces

$

D6610

Retainer Onlay – cast high noble metal, two surfaces

$

D6611

Retainer Onlay – cast high noble metal, three or more surfaces

$

D6612

Retainer Onlay – cast predominantly base metal, two surfaces

$

D6613

Retainer Onlay – cast predominantly base metal, three or more surfaces

$

D6614

Retainer Onlay – cast noble metal, two surfaces

$

D6615

Retainer Onlay – cast noble metal, three or more surfaces

$

D6624

Retainer Inlay – titanium

$

D6634

Retainer Onlay – titanium

$

D6710

Retainer Crown – indirect resin based composite

$

D6720

Retainer Crown – resin with high noble metal

$

D6721

Retainer Crown – resin with predominantly base metal

$

D6722

Retainer Crown – resin with noble metal

$

D6740

Retainer Crown – porcelain/ceramic

$

D6750

Retainer Crown – porcelain fused to high noble metal

$

D6751

Retainer Crown – porcelain fused to predominantly base metal

$

D6752

Retainer Crown – porcelain fused to noble metal

$

D6780

Retainer Crown – ¾ cast high noble metal

$

D6781

Retainer Crown – ¾ cast predominantly base metal

$

D6782

Retainer Crown – ¾ cast noble metal

$

D6783

Retainer Crown – ¾ porcelain/ceramic

$

D6790

Retainer Crown – full cast high noble metal

$

D6791

Retainer Crown – full cast predominantly base metal

$

D6792

Retainer Crown – full cast noble metal

$

D6793

Provisional retainer crown – further treatment or completion of diagnosis necessary prior to final impression

$

D6794

Retainer Crown – titanium

$

D6920

Connector bar

$

D6930

Re–cement or re–bond fixed partial denture

$

D6940

Stress breaker

$

D6950

Precision attachment

$

D6980

Fixed partial denture repair necessitated by restorative material failure

$

D6985

Pediatric partial denture, fixed

$

D6999

Unspecified fixed prosthodontic procedure, by report

$

X. ORAL & MAXILLOFACIAL SURGERY

D7111

Extraction, coronal remnants – deciduous tooth

$

D7140

Extraction, erupted tooth or exposed root (elevation and/or forceps removal)

$

D7210

Surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated

$

D7220

Removal of impacted tooth – soft tissue

$

D7230

Removal of impacted tooth – partially bony

$

D7240

Removal of impacted tooth – completely bony

$

D7241

Removal of impacted tooth – completely bony, with unusual surgical complications

$

D7250

Surgical removal of residual tooth roots (cutting procedure)

$

D7251

Coronectomy – intentional partial tooth removal

$

D7260

Oroantral fistula closure

$

D7261

Primary closure of a sinus perforation

$

D7270

Tooth re–implantation and/or stabilization of accidentally evulsed or displaced tooth

$

D7272

Tooth transplantation (includes re–implantation from one site to another and splinting and/or stabilization)

$

D7280

Surgical access of an unerupted tooth

$

D7282

Mobilization of erupted or malpositioned tooth to aid eruption

$

D7283

Placement of device to facilitate eruption of impacted tooth

$

D7285

Incisional biopsy of oral tissue – hard (bone, tooth)

$
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