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D8693

Re–cement or re-bond fixed retainer

$

D8694

Repair of fixed retainers, includes reattachment

$

D8999

Unspecified orthodontic procedure, by report

$

XII. ADJUNCTIVE GENERAL SERVICES

D9110

Palliative (emergency) treatment of dental pain – minor procedure

$

D9120

Fixed partial denture sectioning

$

D9210

Local anesthesia not in conjunction with operative or surgical procedures

$

D9211

Regional block anesthesia

$

D9212

Trigeminal division block anesthesia

$

D9215

Local anesthesia in conjunction with operative or surgical procedures

$

D9219

Evaluation for deep sedation or general anesthesia

$

D9223

Deep sedation/general anesthesia – each 15 minute increment

$

D9230

Inhalation of nitrous oxide/analgesia, anxiolysis

$

D9243

Intravenous moderate (conscious) sedation/analgesia – each 15 minute increment

$

D9248

Non-intravenous conscious sedation

$

D9310

Consultation – diagnostic service provided by dentist or physician other than requesting dentist or physician

$

D9410

House/extended care facility call

$

D9420

Hospital or ambulatory surgical center call

$

D9430

Office visit for observation (during regularly scheduled hours) – no other services performed

$

D9440

Office visit – after regularly scheduled hours

$

D9450

Case presentation, detailed and extensive treatment planning

$

D9610

Therapeutic parenteral drug, single administration

$

D9612

Therapeutic parenteral drugs, two or more administrations, different medications

$

D9630

Other drugs and/or medicaments, by report

$

D9910

Application of desensitizing medicament

$

D9911

Application of desensitizing resin for cervical and/or root surface, per tooth

$

D9920

Behavior management, by report

$

D9930

Treatment of complications (post-surgical) – unusual circumstances, by report

$

D9932

Cleaning and inspection of removable complete denture, maxillary

$

D9933

Cleaning and inspection of removable complete denture, mandibular

$

D9934

Cleaning and inspection of removable partial denture, maxillary

$

D9935

Cleaning and inspection of removable partial denture, mandibular

$

D9940

Occlusal guard, by report

$

D9941

Fabrication of athletic mouthguard

$

D9942

Repair and/or reline of occlusal guard

$

D9943

Occulsal guard adjustment

$

D9950

Occlusion analysis – mounted case

$

D9951

Occlusal adjustment – limited

$

D9952

Occlusal adjustment – complete

$

D9970

Enamel microabrasion

$

D9971

Odontoplasty 1–2 teeth; includes removal of enamel projections

$

D9972

External bleaching – per arch –performed in office

$

D9973

External bleaching – per tooth

$

D9974

Internal bleaching – per tooth

$

D9975

External bleaching for home application, per arch; includes materials and fabrication of custom trays

$

D9985

Sales tax

$

D9986

Missed appointment

$

D9987

Cancelled appointment

$

D9999

Unspecified adjunctive procedure, by report

$



October 2015
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