DENTAL FEE SCHEDULE Effective 01/01 . - Mississippi Medicaid
DENTAL FEE SCHEDULE Effective 01/01/2020Print Date: 05/05/2020Current Dental Terminology (including procedure codes, nomenclature, descriptors and other data contained therein)is copyright 2019 American Dental Association. All rights reserved. Applicable FARS/DFARS Apply.Pricing does not include cutbacks, assessment fees, etc. Payment is not guaranteed.CodeD0120Code StatusFee on FileD0140Fee on FileD0145Fee on FileD0150Fee on FileD0160Not CoveredD0170Not CoveredD0171Not CoveredD0180Not CoveredD0190Not CoveredDescriptionPERIODIC ORAL EXAM ESTABLISHEDPATIENTLIMITED ORAL EVALUATION - PROBLEMFOCUSEDORAL EVALUATION FOR A PATIENTUNDER THREE YEARS OF AGE ANDCOUNSELING WITH PRIMARYCOMPREHENSIVE ORAL EVALUATION NEW OR ESTABLISHED PATIENTCOMPREHENSIVEDETAILED AND EXTENSIVE ORALEVALUATION - PROBLEM FOCUSED, BYREPORTRE-EVALUATION-LIMITED, PROBLEMFOCUSED (ESTABLISHED PATIENT; NOTPOST-OPRE-EVALUATION POST OPERATIVEOFFICE VISITCOMPREHENSIVE PERIODONTALEVALUATION - NEW OR ESTABLISHEDPATIENTSCREENING OF A PATIENTD0191Not CoveredASSESSMENT OF A PATIENT099901/01/201312/31/999910.00D0210Fee on File099907/01/201412/31/9999166.32D0220Fee on File099907/01/201412/31/9999113.26D0230Fee on File099907/01/201412/31/99991311.94D0240Not Covered099907/01/198312/31/999910.00D0250Not Covered099907/01/198312/31/999910.00D0251Not Covered099901/01/201612/31/999910.00D0270Fee on File099907/01/201412/31/9999113.36D0272Fee on FileINTRAORAL-COMPLETE SERIES OFRADIOGRAPHIC IMAGESINTRAORAL-PERIAPICAL FIRSTRADIOGRAPHIC IMAGEINTRAORAL-PERIAPICAL EACHADDITIONAL RADIOGRAPHIC IMAGEINTRAORAL-OCCLUSAL RADIOGRAPHICIMAGEEXTRA-ORAL - 2D PROJECTIONRADIOGRAPHIC IMAGE CREATED USINGA STATIONARY RADIATION SOURCE,AND DETECTOREXTRA-ORAL POSTERIOR DENTALRADIOGRAPHIC IMAGEBITEWING-SINGLE RADIOGRAPHICIMAGEBITEWINGS-TWO RADIOGRAPHIC099907/01/201412/31/9999121.37D0273Fee on File099907/01/201412/31/9999126.05D0274Fee on File099907/01/201412/31/9999130.06D0277Not Covered099901/01/200012/31/999910.00D0310Not WINGS-FOUR RADIOGRAPHICIMAGESVERTICAL BITEWINGS-7 TO 8RADIOGRAPHIC 0Not d by PA Yes099912/01/200812/31/999920.00D0322Not CoveredTEMPOROMANDIBULAR JOINTARTHROGRAM, INCLUDING INJECTIONOTHER TEMPOROMANDIBULAR JOINTRADIOGRAPHIC IMAGES BY REPORTTOMOGRAPHIC SURVEY099912/01/199212/31/999999990.00D0330Fee on FilePANORAMIC RADIOGRAPHIC IMAGE099907/01/201412/31/9999154.52D0340Fee on File2D CELPHALOMETRIC RADIOGRAPHICIMAGE - ACQUISITION, MEASUREMENTAND ANALYSIS02007/01/201412/31/9999161.56PAMin Age Max Age Begin Date020 02/01/2018End Date Max 910.00
CodeD0350Code StatusFee on FileD0351Not CoveredD0364Not CoveredD0365Not CoveredD0366Not CoveredD0367Not CoveredD0368Not CoveredD0369Not CoveredD0370Not CoveredD0371Not CoveredD0380Not CoveredD0381Not CoveredD0382Not CoveredD0383Not CoveredD0384Not CoveredD0385Not CoveredD0386Not CoveredD0391Not CoveredD0393Not CoveredD0394Not CoveredD0395Not CoveredD0411Fee on FileD0412Not CoveredD0414Not CoveredPADescriptionMin Age Max Age Begin Date2D ORAL/FACIAL PHOTOGRAPHIC IMAGE020 07/01/2014OBTAINED INTRA-ORALLY OR EXTRAORALLY3D PHOTOGRAHIC IMAGE020 01/01/2015End Date Max Units12/31/9999112/31/999910.00CONE BEAM CT CAPTURE ANDINTERPRETATION WITH LIMITED FIELDOF VIEW- LESS THAN ONE WHOLE JAWCONE BEAM CT CAPTURE ANDINTERPRETATION WITH FIELD OF VIEWOF ONE FULL DENTAL ARCH-MANDIBLECONE BEAM CT CAPTURE ANDINTERPRETATION WITH FIELD OF VIEWOF ONE FULL DENTAL ARCH-MAXILLA,WITH OR WITHOUT CRANIUMCONE BEAM CT CAPTURE ANDINTERPRETATION WITH FIELD OF VIEWOF BOTH JAWS WITH OR WITHOUTCRANIUMCONE BEAM CT CAPTURE ANDINTERPRETATION FOR TMJ SERIESINCLUDING TWO OR MORE EXPOSURESMAXILLOFACIAL MRI CAPTURE ANDINTERPRETATIONMAXILOFACIAL ULTRASOUND CAPTUREAND INTERPRETATIONSIALOENDOSCOPY CAPTURE ANDINTERPRETATIONCONE BEAM CT IMAGE CAPTURE WITHLIMITED FIELD OF VIEW-LESS THAN ONEWHOLE JAWCONE BEAM CT IMAGE CAPTURE WITHFIELD OF VIEW OF ONE FULL DENTALARCH-MANDIBLECONE BEAM CT INMAGE CAPTURE WITHFOELD OF VIEW OF ONE FULL DENTALARCH-MAXILLA, WITH OR WITHOUTCRANIUMCONE BEAM CT IMAGE CAPTURE WITHFIELD OF VIEW OF VIEW OF BOTH JAWS,WITH OR WOTHOUT CRAMIUMCONE BEAM CT IMAGE CAPTURE FORTMJ SERIES INCLUDING TWO OR MOREEXPOSURESMAXILLOFACIAL MRI IMAGE /31/999910.00MAXILLOFACIAL ULTRASOUND IMAGECAPTUREINTERPRETATION OF DIAGNOSTICIMAGE BY A PRACTITIONER NOTASSOCIATED WITH CAPTURE OF THEIMAGE, INCLUDING REPORTTREATMENT SIMULATION USING 3DIMAGE VALUMEDIGITAL SUBTRACTION OF TWO ORMORE IMAGES OR IMAGE VOLUMES OFTHE SAME MODALITYFUSION OF TWO OR MORE 3D IMAGEVOLUMES OF ONE OR MOREHBA1C IN-OFFICE POINT OF SERVICETESTINGBLOOD GLUCOSE LEVEL TEST INOFFICE USING A GLUCOSE METERLAB PROCESSING OF MICROBIALSPECIMEN INCLUDE CULTURESENSITIVITY STUDIES, PREP, ANDTRANSMISSION OF WRITTEN 1/999910.00099901/01/201712/31/999910.00Fee29.32
DescriptionMin Age Max Age Begin DateCOLLECTION OF MICROORGANISMS FOR0999 12/01/1992CULTURE AND SENSITIVITYVIRAL CULTURE0999 01/01/2005End Date Max Units12/31/9999999912/31/999910.00COLLECTION & PREPARATION OF SALIVASAMPLE FOR LABORATORY DIAGNOSTICTESTANALYSIS OF SALIVA 0ASSESSMENT OF SALIVARY FLOW BYMEASUREMENTCOLLECTION AND PREPARATION OFGENETIC SAMPLE MATERIAL FORLABORATORY ANALYSIS AND REPORTGENETIC TEST FOR SUSCEPTIBILITY TODISEASE - SPECIMEN ANALYSISCARIES SUSCEPTIBILITY .00Not CoveredADJUNCTIVE PRE-DIAGNOSTIC TESTTHAT AIDS IN DETECTION OF MUCOSALABNORMALITIESPULP VITALITY TESTS099901/01/197012/31/999910.00Fee on FileDIAGNOSTIC CASTS02007/01/201412/31/9999165.75D0472Not Covered099901/01/200012/31/999910.00D0473Not Covered099901/01/200012/31/999910.00D0474Not Covered099901/01/200012/31/999910.00D0475Not CoveredACCESSION OF TISSUE, GROSSEXAMINATION, PREPARATION ANDTRANSMISSION OFACCESSION OF TISSUE, GROSS ANDMICROSCOPIC EXAMINATION,PREPARATION ANDACCESSION OF TISSUE, GROSS ANDMICROSCOPIC EXAMINATION,INCLUDING ASSESSDECALCIFICATION PROCEDURE099901/01/200512/31/999910.00D0476Not CoveredSPECIAL STAINS FOR t Covered099901/01/200512/31/999910.00D0478Not CoveredSPECIAL STAINS, NOT FORMICROORGANISMSIMMUNOHISTOCHEMICAL STAINS099901/01/200512/31/999910.00D0479Not Covered099901/01/200512/31/999910.00D0480Not Covered099901/01/200012/31/999910.00D0481Not CoveredTISSUE IN-SITU HYBRIDIZATION,INCLUDING INTERPRETATIONACCESSION OF EXFOLIATIVECYTOLOGIC SMEARS, MICROSCOPICEXAMINATION, PREPARATION ANDTRANSMISSION OF WRITTEN REPORTELECTRON D0482Not CoveredDIRECT 83Not CoveredINDIRECT 84Not Covered099901/01/200512/31/999910.00D0485Not Covered099901/01/200512/31/999910.00D0486Not Covered099901/01/200712/31/999910.00D0502Not Covered099912/10/199112/31/9999999990.00D0600Not Covered099901/01/201712/31/999910.00D0601Not CoveredCONSULTATION ON SLIDES PREPAREDELSEWHERECONSULTATION, INCLUDINGPREPARATION OF SLIDES FROM BIOPSYMATERIAL SUPPLIED BYACCESSION TRANSEPITHELIALCYTOLOGIC SAMPLE, MICROSCOPICEXAMINATION, PREPARATION ANDTRASNMISSION OF WRITTEN REPORTOTHER ORAL PATHOLOGYPROCEDURES, BY REPORTNON-IONIZING DIAGNOSTIC PROCEDURECAPABLE OF QUANTIFYING,MONITORING, AND RECORDINGCHANGES IN STRUCTURE OF ENAMEL,DENTIN AND CEMENTUMCARIES RISK ASSESSMENT ANDDOCUMENTATION, WITH A FINDING OFLOW RISK099901/01/201412/31/999910.00CodeD0415Code StatusNot CoveredD0416Not CoveredD0417Not CoveredD0418Not CoveredD0419Not CoveredD0422Not CoveredD0423Not CoveredD0425Not CoveredD0431Not CoveredD0460D0470PA99901/01/2009Fee0.00
CodeD0602Code StatusNot CoveredD0603Not CoveredD0999Priced by PA YesD1110Not CoveredDescriptionMin Age Max Age Begin DateCARIES RISK ASSESSMENT AND0999 01/01/2014DOCUMENTATION, WITH A FINDING OFMODERATE RISKCARIES RISK ASSESSMENT AND0999 01/01/2014DOCUMENTATION, WITH A FINDING OFHIGH RISKUNSPECIFIED DIAGNOSTIC PROCEDURE,0999 10/01/2003BY REPORTPROPHYLAXIS - ADULT0999 01/01/1970D1120Fee on FilePROPHYLAXIS - CHILD02007/01/201412/31/9999130.11D1206Fee on File02007/01/201412/31/9999125.05D1208Fee on FileTOPICAL APPLICATION OF FLUORIDEVARNISHTOPICAL APPLICATION OF FLUORIDE02007/01/201412/31/9999116.70D1310Not Covered099901/01/197012/31/999910.00D1320Not Covered099901/01/199612/31/999910.00D1330Not CoveredNUTRITIONAL COUNSELING FOR THECONTROL OF DENTAL DISEASETOBACCO COUNSELING FOR THECONTROL AND PREVENTION OF ORALDISEASEORAL HYGIENE INSTRUCTION099901/01/197012/31/999910.00D1351Fee on FileSEALANT - PER TOOTH02007/01/201412/31/9999128.39D1352Not Covered099901/01/201112/31/999910.00D1353Not CoveredPREVENTATIVE RESIN RESTORATION INA MODERAT TO HIGH CARIES RISKPATIENT-PERMANENT TOOTHSEALANT REPAIR- PER TOOTH02001/01/201512/31/999910.00D1354Not Covered099901/01/201612/31/999910.00D1510Fee on File02007/01/201412/31/99994179.20D1516Fee on File02001/01/201912/31/99992250.88D1517Fee on File02001/01/201912/31/99992250.88D1520Fee on File02007/01/201412/31/99994197.12D1526Fee on File02001/01/201912/31/99992304.64D1527Fee on File02001/01/201912/31/99992304.64D1551Fee on File02001/01/202012/31/9999238.71D1552Fee on File02001/01/202012/31/9999238.71D1553Fee on File02001/01/202012/31/9999438.71D1556Fee on File02001/01/202012/31/9999437.27D1557Fee on File02001/01/202012/31/9999137.27D1558Fee on File02001/01/202012/31/9999137.27D1575Not Covered099901/01/201712/31/999910.00D1999Not Covered099901/01/201412/31/999910.00D2140Fee on File02007/01/201412/31/9999169.58D2150Fee on File02007/01/201412/31/9999190.05D2160Fee on FileINTERIM CARIES ARRESTINGMEDICAMENT APPLICATION - PERSPACE MAINTAINER - FIXED,UNILATERAL - PER QUADRANTSPACE MAINTAINER - FIXED - BILATERAL,MAXILLARYSPACE MAINTAINER - FIXED - BILATERAL,MANDIBULARSPACE MAINTAINER - REMOVABLE,UNILATERAL - PER QUADRANTSPACE MAINTAINER - FIXED - BILATERAL,MAXILLARYSPACE MAINTAINER - FIXED - BILATERAL,MANDIBULARRE-CEMENT OR RE-BOND BILATERALSPACE MAINTAINER-MAXILLARYRE-CEMENT OR RE-BOND BILATERALSPACE MAINTAINER-MANDIBULARRE-CEMENT OR RE-BOND UNILATERALSPACE MAINTAINER-PER QUADRANTREMOVAL OF FIXED UNILATERAL SPACEMAINTAINER- PER QUADRANTREMOVAL OF FIXED BILATERAL SPACEMAINTAINER-MAXILLARYREMOVAL OF FIXED BILATERAL SPACEMAINTAINER- MANDIBULARDISTAL SHOE SPACE MAINTAINER FIXED, UNILATERAL - PER QUADRANTUNSPECIFIED PREVENTIVEPROCEDURE, BY REPORTAMALGAM-ONE SURFACE, PRIMARY ORPERMANENT AMALGAM-ONE SURFACE,PRIMARY OAMALGAM-TWO SURFACES, PRIMARYOR PERMANENT AMALGAM-TWOSURFACES, PRIMARYAMALGAM-THREE SURFACES, PRIMARYOR PERMANENT AMALGAM-THREESURFACES, PRI02007/01/201412/31/99991108.87PAEnd Date Max .0012/31/999910.00
CodeD2161Code StatusFee on FileD2330Fee on FileDescriptionAMALGAM-FOUR OR MORE SURFACES,PRIMARY OR PERMANENT AMALGAMFOUR OR MORERESIN-ONE SURFACE, ANTERIOR02007/01/201412/31/99991D2331Fee on FileRESIN-TWO SURFACES, ANTERIOR02007/01/201412/31/9999193.03D2332Fee on FileRESIN-THREE SURFACES, ANTERIOR02007/01/201412/31/99991113.85D2335Fee on File02007/01/201412/31/99991134.68D2390Fee on File02007/01/201412/31/99991149.26D2391Fee on File02007/01/201412/31/9999185.39D2392Fee on File02007/01/201412/31/99991111.77D2393Fee on File02007/01/201412/31/99991138.85D2394Fee on File02007/01/201412/31/99991170.09D2410Not CoveredRESIN-FOUR OR MORE SURFACES ONINVOLVING INCISAL ANGLERESIN-BASED COMPOSITE CROWN,ANTERIORRESIN-BASED COMPOSITE - ONESURFACE, POSTERIORRESIN-BASED COMPOSITE - TWOSURFACES, POSTERIORRESIN-BASED COMPOSITE - THREESURFACES, POSTERIORRESIN-BASED COMPOSITE - FOUR ORMORE SURFACES, POSTERIORGOLD FOIL - ONE SURFACE099901/01/197012/31/999910.00D2420Not CoveredGOLD FOIL - TWO SURFACES099901/01/197012/31/999910.00D2430Not CoveredGOLD FOIL - THREE SURFACES099901/01/197012/31/999910.00D2510Not CoveredINLAY - METALLIC - ONE SURFACE099901/01/197012/31/999910.00D2520Not CoveredINLAY - METALLIC -TWO SURFACES099901/01/197012/31/999910.00D2530Not CoveredINLAY - METALLIC - THREE SURFACES099901/01/197012/31/999910.00D2542Not CoveredONLAY-METALLIC-TWO SURFACES099901/01/200012/31/999910.00D2543Not CoveredONLAY - METALLIC - THREE SURFACES099901/01/199612/31/999910.00D2544Not Covered099901/01/199612/31/999910.00D2610Not Covered099901/01/197012/31/999910.00D2620Not Covered099912/10/199112/31/9999999990.00D2630Not Covered099912/10/199112/31/9999999990.00D2642Not Covered099901/01/199612/31/999910.00D2643Not Covered099901/01/199612/31/999910.00D2644Not Covered099901/01/199612/31/999910.00D2650Not Covered099912/01/199212/31/999999990.00D2651Not Covered099912/01/199212/31/999999990.00D2652Not Covered099912/01/199212/31/999999990.00D2662Not Covered099901/01/199612/31/999910.00D2663Not Covered099901/01/199612/31/999910.00D2664Not Covered099901/01/199612/31/999910.00D2710Not Covered099901/01/197012/31/999910.00D2712Not Covered099901/01/200512/31/999910.00D2720Not CoveredONLAY - METALLIC - FOUR OR MORESURFACESINLAY - PORCELAIN/CERAMIC - ONESURFACEINLAY - PORCELAIN/CERAMIC-TWOSURFACESINLAY - PORCELAIN/CERAMIC-THREESURFACESONLAY - PORCELAIN/CERAMIC - TWOSURFACESONLAY - PORCELAIN/CERAMIC - THREESURFACESONLAY - PORCELAIN/CERAMIC - FOUROR MORE SURFACESINLAY - RESIN-BASED COMPOSITE - ONESURFACE INLAY - RESIN-BASEDCOMPOSITINLAY - RESIN-BASED COMPOSITE - TWOSURFACES INLAY - RESIN-BASEDCOMPOSIINLAY - RESIN-BASED COMPOSITE THREE OR MORE SURFACES INLAY RESIN-BASONLAY - RESIN-BASED COMPOSITE TWO SURFACES ONLAY - RESIN-BASEDCOMPOSIONLAY - RESIN-BASED COMPOSITE THREE SURFACES ONLAY - RESINBASED COMPOONLAY - - RESIN-BASED COMPOSITE FOUR OR MORE SURFACES ONLAY - RESINCROWN-RESIN-BASED COMPOSITE(INDIRECT)CROWN - 3/4 RESIN-BASED COMPOSITE(INDIRECT)CROWN-RESIN WITH HIGH NOBLE METAL099901/01/197012/31/999910.00PAMin Age Max Age Begin Date020 07/01/2014End Date Max Units12/31/99991Fee132.6172.89
CodeD2721Code StatusNot CoveredPAD2722Not CoveredD2740Not CoveredD2750Fee on FileYesD2751Fee on FileYesD2752Fee on FileYesD2753Not CoveredD2780Not CoveredD2781Not CoveredD2782D2783DescriptionCROWN-RESIN WITH PREDOMINANTLYBASE METALCROWN-RESIN WITH NOBLE METALMin Age Max Age Begin Date0999 01/01/1970End Date Max 00CROWN-PORCELAIN/CERAMICSUBSTRATECROWN-PORCELAIN FUSED TO HIGHNOBLE METALCROWN-PROCELAIN FUSED TOPREDOMINANTLY BASE METALCROWN-PORCELAIN FUSED TO NOBLEMETALCROWN- PORCELAIN FUSED TOTITANIUM AND TITANIUM ALLOYSCROWN - 3/4 CAST HIGH NOBLE 2/31/999910.00Not CoveredCROWN - 3/4 CAST PREDOMINANTLYBASE METALCROWN - 3/4 CAST NOBLE METAL099901/01/200012/31/999910.00Not CoveredCROWN - 3/4 0Not CoveredCROWN - FULL CAST HIGH NOBLE METAL099901/01/197012/31/999910.00D2791Not Covered099909/01/198612/31/9999999990.00D2792Not CoveredCROWN - FULL CAST PREDOMINANTLYBASE METALCROWN - FULL CAST NOBLE METAL099901/01/197012/31/999910.00D2794Not Covered099901/01/200512/31/999910.00D2799Not Covered099901/01/200012/31/999910.00D2910Not Covered099901/01/197012/31/999910.00D2915Not Covered099901/01/200512/31/999910.00D2920Not CoveredCROWN - TITANIUM AND TITANIUMALLOYSPROVISIONAL CROWN-FURTHERTREATMENT OR COMPLETION OFDIAGNOSIS NECESSARY PRIOR TO FINALIMPRESSIONRECEMENT INLAY, ONLAY OR PARTIALCOVERAGE RESTORATIONRECEMENT CAST OR PREFABRICATEDPOST AND CORERECEMENT CROWN099901/01/197012/31/999910.00D2921Not Covered099901/01/201412/31/999910.00D2929Not Covered099901/01/201312/31/999910.00D2930Fee on File02007/01/201412/31/99991134.79D2931Fee on File02007/01/201412/31/99991152.40D2932Not CoveredREATTACHMENT OF TOOTH FRAGMENT,INCISAL EDGE OR CUSPPREFABRICATED PORCELAIN/CERAMICCROWN-PRIMARY TOOTHPREFABRICATED STAINLESS STEELCROWN - PRIMARY TOOTHPREFABRICATED STAINLESS STEELCROWN - PERMANENT TOOTHPREFABRICATED RESIN CROWN099912/10/199112/31/9999999990.00D2933Fee on File02007/01/201412/31/99991186.27D2934Fee on File02007/01/201412/31/99991186.27D2940Fee on File02007/01/201412/31/9999151.48D2941Not Covered099901/01/201412/31/999910.00D2949Not Covered099901/01/201412/31/999910.00D2950Not Covered099901/01/197012/31/999910.00D2951Not Covered02012/10/199112/31/9999999990.00D2952Fee on File02007/01/201412/31/99991203.21D2953Not Covered099901/01/200012/31/999910.00D2954Not CoveredPREFABRICATED STAINLESS STEELCROWN WITH RESIN WINDOWPREFABRICATED ESTHETIC COATEDSTAINLESS STEEL CROWN - PRIMARYTOOTHPROTECTIVE RESTORATION POSTREMOVALINTERIM THERAPEUTIC RESTORATIONPRIMARY DENTITIONRESTORATIVE FOUNDATION FOR ANINDIRECT RESTORATIONCORE BUILDUP, INCLUDING ANY PINSWHEN REQUIREDPIN RETENTION - PER TOOTH, INADDITION TO RESTORATIONPOST AND CORE IN ADDITION TOCROWN, INDIRECTLY FABRICATEDEACH ADDITIONAL INDIRECTLYFABRICATED POST - SAME TOOTHPREFABRICATED POST AND CORE INADDITION TO CROWN099912/10/199112/31/9999999990.00YesYes
CodeD2955Code StatusNot CoveredPAD2957Not CoveredD2960Not CoveredD2961Not CoveredD2962Not CoveredD2971Not CoveredD2975Not CoveredD2980Not CoveredD2981Not CoveredD2982Not CoveredD2983Not CoveredD2990Not CoveredD2999Priced by PA YesD3110Not CoveredD3120Not CoveredD3220Fee on FileD3221Not CoveredD3222Fee on FileD3230Not CoveredD3240Not CoveredD3310Fee on FileD3320Fee on FileD3330Fee on FileD3331Not CoveredD3332Not CoveredD3333Not CoveredD3346Fee on FileYesD3347Fee on FileYesD3348Fee on FileYesDescriptionPOST REMOVAL (NOT IN CONJUCTIONWITH ENDODONTIC THERAPY)EACH ADDITIONAL PREFABRICATEDPOST - SAME TOOTHLABIAL VENEER (LAMINATE)-CHAIRSIDEMin Age Max Age Begin Date0999 01/01/1996End Date Max 00099907/28/198612/31/999910.00LABIAL VENEER (RESIN LAMINATE)LABORATORYLABIAL VENEER (PORCELAIN LAMINATE)LABORATORYADDITIONAL PROCEDURES TOCONSTRUCT NEW CROWN UNDEREXISTING PARTIAL 910.00099901/01/200512/31/999910.00CROWN REPAIR NECESSITATED BYRESTORATIVE MATERIAL FAILUREINLAY REPAIR NECESSITAED BYRESTORATIVE MATERIAL FAILUREONLAY REPAIR NECESSITATED BYRESTORATIVE MATERIAL FAILUREVANEER REPAIR NECESSITATED BYRESTORATIVE MATERIAL FAILURERESIN INFILTRATION OF INCIPIENTSMOOTH SURFACE LESIONSUNSPECIFIED RESTORATIVEPROCEDURE, BY REPORTPULP CAP - DIRECT (EXCLUDING FINALRESTORATION)PULP CAP -INDIRECT (EXCLUDING FINALRESTORATION)THERAPEUTIC PULPOTOMY (EXCLUDINGFINAL RESTORATION) REMOVAL OFPULP CORPULPAL DEBRIDEMENT, PRIMARY ANDPERMANENT TEETH PULPALDEBRIDEMENT, PRIMPARTIAL PULPOTOMY FORAPEXOGENESIS - PERMANENT TOOTHWITH INCOMPLETED ROOTDEVELOPMENTPULPAL THERAPY (RESORBABLEFILLING)-ANTERIOR, PRIMARY TOOTH(EXCLUDING FPULPAL THERAPY (RESORBABLEFILLING)-POSTERIOR, PRIMARY TOOTH(EXCLUDINGENDODONTIC THERAPY, ANTERIORTOOTH (EXCLUDING FINALENDODONTIC THERAPY, PREMOLARBICUSPID TOOTH (EXCLUDING FINALRESTORATION)ENDODONTIC THERAPY, MOLAR TOOTH(EXCLUDING FINAL RESTORATION)TREATMENT OF ROOT CANALOBSTRUCTION;
d0330 fee on file panoramic radiographic image 0 999 07/01/2014 12/31/9999 1 54.52 d0340 fee on file 2d celphalometric radiographic image - acquisition, measurement and analysis 0 20 07/01/2014 12/31/9999 1 61.56 dental fee schedule effective 01/01/2020 print date: 05/05/2020
DENTAL SCIENCES 1 Chapter 1 I Dental Assisting— The Profession 3 The Career of Dental Assisting 4 Employment for the Dental Assistant 4 The Dental Team 6 Dental Jurisprudence and Ethics 12 Dental Practice Act 12 State Board of Dentistry 12 The Dentist, the Dental Assistant, and the Law 13 Standard of Care 13 Dental Records 14 Ethics 14
Cigna Dental Care DMO Patient Charge Schedules 887394 09/15 CDT 2016 Covered under Procedure Code1 Dental Description and Nomenclature Cigna Dental 01 and 02 PCS Cigna Dental 03 PCS Cigna Dental 04 PCS Cigna Dental 05 PCS Cigna Dental 06 PCS Cigna Dental 07 PCS Cigna Dental 08 PCS Chair Time Per Y/N Minutes Code # (if different) Y/N Code # (if .
A dental fee schedule lists the discounted prices that members of your dental plan pay for dental services. Obtain a copy of your CignaPlus Savings Powered By Cigna Dental Network Access fee schedule by logging into the DentalPlans.com Member's Area. Fee schedules for Cigna Dental Network Access are specific to the dentist you have selected.
Dental Fee Schedule _ GENERAL INFORMATION AND INSTRUCTIONS 1. A. Reimbursement for services listed in the New York State Fee Schedule for Dental Services is limited to the lower of the fee indicated for the specific service or the provider's usual and customary charge to the general publ
is a detailed list of dental services provided by a dental office and given to Delta Dental for payment. Delta Dental means Delta Dental Plan of Michigan, Inc., a service provider for dental benefits under the Michigan Dental Program. Delta Dental ID Card is a permanent (not monthly) card. We send
Mid-level dental providers, variously referred to as dental therapists, dental health aide therapists and registered or licensed dental practitioners, work as part of the dental team to provide preventive and routine dental services, such as cleanings and fillings. Similar to how nurse practitioners work alongside physicians, mid-level dental .
0 DELTA DENTAL Delta Dental of North Carolina Employers continue to choose Delta Dental for their dental benefits! More than 1,000 organizations across North Carolina have selected their dental benefits through Delta Dental of North Carolina. We are excited to welcome our new enrollees from the following employer groups, effective January 1, 2021.
for coronavirus (COVID-19) for people taking a coronavirus test at a GP with help from the staff This is an easy read guide. January 2021. 2 Contents Introduction Prepare to test Throat swab Get your test results Nose swab For more information Page 3 Page 7 Page Page 10 Page 12 6 Page 14 5 4 3 2 1. 3 Introduction This guide comes from the Government’s Department of Health and Social Care .
