1 of 46 documents new jersey administrative code



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NOTE: Up to and including three cm.




D7441

22

Excision of Malignant

473.00




413.00










Tumor--Lesion Diameter Over 3 cm.













D7450




Removal of Odontogenic Cyst or

50.00




43.00










Tumor--Lesion Diameter Up to 1.25



















cm.













D7451




Removal of Odontogenic Cyst or

100.00




87.00










Tumor--Lesion Diameter Over 1.25



















cm.










NOTE: Up to and including three cm.




D7451

22

Removal of Odontogenic Cyst or

150.00




130.00










Tumor--Lesion Diameter Over 3 cm.













D7460




Removal of Non Odontogenic Cyst or

50.00




43.00










Tumor--Lesion Diameter Up to 1.25



















cm.













D7461




Removal of Non Odontogenic Cyst or

100.00




87.00










Tumor--Lesion Diameter Over 1.25



















cm.










NOTE: Up to and including three cm.




D7461

22

Removal of Non Odontogenic Cyst or

150.00




130.00










Tumor--Lesion Diameter Over 3 cm.













D7465




Destruction of Lesion(s) by

18.00




15.00










Physical Methods: Electrosurgery,



















Chemotherapy, Cryotherapy or Laser










(h) Excision of bone tissue:




D7471




Removal of Exostosis--per site

62.50




56.50

1. Reimbursement will be based upon quadrants.

NOTE: Per quadrant.






D7471

22

Removal of Exostosis

109.00




98.00

NOTE: Torus palatinus.




D7480




Partial Ostectomy (Guttering or

211.00




184.00










Saucerization)













D7490




Radical Resection of Mandible with

807.00




807.00










Bone Graft










(i) Surgical incision:




D7510




Incision and Drainage of

28.00




26.00










Abscess--Intraoral Soft Tissue













D7520




Incision and Drainage of

42.00




37.00










Abscess--Extraoral Soft Tissue













D7530




Removal of Foreign Body, Skin, or

18.00




16.00










Subcutaneous Areolar Tissue













D7540




Removal of Reaction Producing

51.00




45.00










Foreign Bodies, Musculoskeletal



















System













D7550




Sequestrectomy for Osteomyelitis

48.00




42.00

NOTE: Intraoral.




D7550

22

Sequestrectomy for Osteomyelitis

90.00




75.00

NOTE: Extraoral.




D7560




Maxillary Sinusotomy for Removal

242.00




210.00










of Tooth Fragment or Foreign Body










NOTE: Sinusotomy, maxillary (antrotomy, Caldwell Luc, unilateral).

(j) Treatment of fractures--simple:



1. Open reduction involves the dissection of tissues and/or the visual inspection of the fracture site.




D7610




Maxilla--Open Reduction (Teeth

273.00




249.00










Immobilized if Present)













D7620




Maxilla--Closed Reduction (Teeth

182.00




166.00










Immobilized if Present)













D7620

52

Maxilla--Closed Reduction

80.00




76.00

NOTE: No manipulation or fixation.




D7630




Mandible--Open Reduction (Teeth

363.00




331.00










Immobilized if Present)













D7630

22

Mandible--Open Reduction (Teeth

454.00




414.00










Immobilized if Present)










NOTE: Complicated--multiple surgical approaches (three or more) including internal fixation, interdental fixation, skeletal pinning with extraoral fixation.




D7640




Mandible--Closed Reduction (Teeth

182.00




166.00










Immobilized if Present)













D7640

52

Mandible--Closed Reduction

80.00




76.00

NOTE: No manipulation or fixation.




D7650




Malar and/or Zygomatic Arch--Open

182.00




166.00










Reduction













D7660




Malar and/or Zygomatic

63.00




58.00










Arch--Closed Reduction










NOTE: Including towel clip technique.




D7660

52

Malar and/or Zygomatic

56.00




52.00










Arch--Closed Reduction










NOTE: No manipulation or fixation.




D7670




Alveolus--Stabilization of Teeth,

138.00




126.00










Open Reduction Splinting










NOTE 1: Alveolar fracture.

NOTE 2: Reduction with wiring, application of arch bar or splint.






D7680




Facial Bones--Complicated

363.00




331.00










Reduction with Fixation and



















Multiple Surgical Approaches










NOTE 1: Maxilla, malar and/or zygomatic arch.

NOTE 2: Multiple surgical approaches (three or more), fixation, traction, head frame, multiple internal and/or external fixation, and head cap.

(k) Treatment of fractures--compound:

1. Open reduction involves the dissection of tissues and/or the visual inspection of the fracture site.






D7710




Maxilla--Open Reduction

273.00




249.00

NOTE: Teeth immobilized if present.




D7720




Maxilla--Closed Reduction

182.00




166.00

NOTE: Teeth immobilized if present.




D7720

52

Maxilla--Closed Reduction

80.00




76.00

NOTE: No manipulation or fixation.




D7730




Mandible--Open Reduction

363.00




331.00

NOTE: Teeth immobilized if present.




D7730

22

Mandible--Open Reduction

454.00




414.00

NOTE: Complicated--multiple surgical approaches (three or more) including internal fixation, interdental fixation, and skeletal pinning with extraoral fixation.




D7740




Mandible--Closed Reduction

182.00




166.00

NOTE: Teeth immobilized if present.




D7740

52

Mandible--Closed Reduction

80.00




76.00

NOTE: No manipulation or fixation.




D7750




Malar and/or Zygomatic Arch--Open

182.00




166.00










Reduction













D7760




Malar and/or Zygomatic

63.00




58.00










Arch--Closed Reduction










NOTE: Including towel clip technique.




D7760

52

Malar and/or Zygomatic

56.00




52.00










Arch--Closed Reduction










NOTE: No manipulation or fixation.




D7770




Alveolus--Stabilization of Teeth,

138.00




126.00










Open Reduction Splinting










NOTE 1: Alveolar fracture.

NOTE 2: Reduction with wiring, application of arch bar or splint.






D7780




Facial Bones--Complicated

363.00




331.00










Reduction with Fixation and



















Multiple Surgical Approaches










NOTE 1: Maxilla, malar and/or zygomatic arch.

NOTE 2: Multiple surgical approaches (three or more), fixation, traction, head frame, multiple internal and/or external fixation, and head cap.



(l) Reduction of dislocation and management of other temporo-mandibular joint dysfunctions:




D7810




Open Reduction of Dislocation

273.00




249.00




D7820




Closed Reduction of Dislocation

27.00




25.00

d

D7830




Manipulation under Anesthesia

27.00




25.00

NOTE: Anesthesia additional.




D7840




Condylectomy

362.00




315.00




D7850




Meniscectomy

362.00




315.00




D7852




Disc repair

362.00




308.00

NOTE: Unilateral.




D7854




Synovectomy

200.00




173.00




D7858




Joint reconstruction

623.00




623.00




D7860




Arthrotomy

182.00




155.00




D7865




Arthroplasty

362.00




308.00

NOTE: Unilateral.

d

D7870




Arthrocentesis

18.00




16.00

NOTE: Injection or aspiration (give complete details).




D7871




Non-arthroscopic lysis and lavage

190.00




190.00




D7872




Arthroscopy--diagnosis, with or

75.00




65.00










without biopsy













D7873




Arthroscopy--surgical: lavage and

200.00




200.00










lysis of adhesions













D7874




Arthroscopy--surgical: disc

500.00




425.00










repositioning and stabilization













D7875




Arthroscopy--surgical: synovectomy

264.00




224.00




D7877




Arthroscopy--surgical: debridement

160.00




136.00

*

D7880




Occlusal orthotic device, by report

BR




BR




D7899




Unspecified TMD therapy, by report

BR




BR

(m) Repair of traumatic wounds:

1. Describe completely, giving size, site, and all pertinent information.

2. Fee includes suture removal.




D7910




Suture of Recent Small Wounds up

35.00




32.00










to 5 cm.










NOTE: 2.5 cm. up to five cm.

(n) Complicated suturing (reconstruction requiring delicate handling of tissues and wide undermining for meticulous closure):



1. Also for irregularly shaped lacerations requiring extensive debridement.




D7911




Complicated suture--Up to 5 cm.

138.00




138.00




D7912




Complicated suture--greater than 5

242.00




242.00










cm.













D7920




Skin graft (identify defect

70.50




70.50










covered, location and type of



















graft)










(o) Other repair procedures:




D7940




Osteoplasty--For Orthognathic

225.00




191.00










Deformities













D7941




Osteotomy--Mandibular rami

726.00




726.00

NOTE: Unilateral.




D7943




Osteotomy--Mandibular rami with

1,058




1,058










bone graft; includes obtaining the



















graft










NOTE: Unilateral.




D7944




Osteotomy--Segmented or

332.00




289.00










subapical--per sextant or quadrant













D7945




Osteotomy--body of mandible

332.00




289.00




D7946




LeFort I (maxilla--total)

546.00




546.00

*

D7947




LeFort I (maxilla--segmented)

365.00




365.00




D7948




LeFort II or LeFort III

1,095




1,095










(Osteoplasty of facial bones for



















midface Hypoplasia or



















retrusion)--without bone graft













D7949




LeFort II or LeFort III--with bone

1,427




1,427










graft













D7950




Osseous, osteoperiosteal, or

575.00




489.00










cartilage graft of the mandible or



















facial bones--autogenous or



















nonautogenous, by report













D7955




Repair of Maxillofacial Soft and

203.00




176.00










Hard Tissue Defects













D7960




Frenulectomy (Frenectomy or

60.00




56.00










Frenotomy)--Separate Procedure













D7970




Excision of hyperplastic

45.00




39.00










tissue--per arch













D7971




Excision of pericoronal gingiva

42.00




37.00




D7980




Sialolithotomy

48.00




42.00




D7981




Excision of Salivary Gland, by

182.00




158.00










report













D7982




Sialodochoplasty

151.00




131.00




D7983




Closure of Salivary Fistula

151.00




131.00




D7990




Emergency Tracheotomy

121.00




105.00




D7991




Coronoidectomy

362.00




308.00

*

D7995




Synthetic graft--mandible or

BR




BR










facial bones, by report













D7996




Implant--mandible for augmentation

BR




BR










purposes (excluding alveolar



















ridge), by report













D7997




Appliance removal (not by dentist

151.00




151.00










who placed appliance), includes



















removal of archbar










**

D7999




Unspecified Oral Surgery

BR




BR










Procedure, By Report










NOTE: Complete description of procedure and the reason the procedure was performed.

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