D0120 |
Periodic oral examination-established patient |
D0150 |
Comprehensive oral examination — new or established patient |
D0272 |
Bitewings — two radiographic images |
D0274 |
Bitewings — four radiographic images |
D1110 |
Prophylaxis--adult |
D1120 |
Prophylaxis — child |
D1206 |
Topical application of fluoride varnish |
D1351 |
Sealant — per tooth |
D2391 |
Resin-based composite — one surface , posterior |
D2392 |
Resin-based composite , two surfaces , posterior |
D7140 |
Extraction , erupted tooth or exposed root ( elevation and / or forceps removal ) |
D0220 |
Intraoral - periapical first radiographic image |
D0230 |
Intraoral - periapical each additional radiographic image |
D1208 |
Topical application of fluoride ¬ excluding varnish |
D2393 |
Resin-based composite – three surfaces , posterior |
D2751 |
Crown – porcelain fused to predominantly base metal |
D4341 |
Periodontal scaling and root planing – four or more teeth per quadrant |
D5110 |
Complete denture – maxillary |
D5120 |
Complete denture – mandibular |
D5213 |
Maxillary partial denture – cast metal framework with resin denture bases |
( including retentive / clasping materials , rests and teeth ) | |
D5214 |
Mandibular partial denture – cast metal framework with resin denture bases |
( including retentive / clasping materials , rests and teeth ) | |
D0330 |
Panoramic radiographic image |
D2140 |
Amalgam – one surface , primary or permanent |
D2150 |
Amalgam – two surfaces , primary or permanent |
D2331 |
Resin-based composite – two surfaces , anterior |
D2930 |
Prefabricated stainless steel crown ¬ primary tooth |
D2933 |
Prefabricated stainless steel crown with resin window |
D3220 |
Therapeutic pulpotomy ( excluding final restoration ) - removal of pulp coronal to the |
dentinocemental junction and application of medicament | |
D3230 |
Pulpal therapy ( resorbable filling ) ¬ anterior , primary tooth ( excluding final restoration ) |
D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
D9230 |
Inhalation of nitrous oxide / analgesia , anxiolysis |