2016 Dental Code Set For dates of service from 1/1/16-12/31/16

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1 HCPCS DESCRIPTIONS D0120 D0140 D0150 D0160 D0180 D0210 D0220 D0230 D0240 D0250 D0260 D0270 D0272 D0273 D0274 D0277 D0290 D0310 D0330 D0340 D0350 D0470 D0502 D1110 D1206 D1208 D1352 D2140 D2150 D2160 D2161 D2330 D2331 PERIODIC ORAL EVALUATION - ESTABLISHED PATIENT LIMITED ORAL EVALUATION - PROBLEM FOCUSED COMPREHENSIVE ORAL EVALUATION - NEW OR ESTABLISHED PATIENT DETAILED AND EXTENSIVE ORAL EVALUATION - PROBLEM FOCUSED, BY REPORT COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT INTRAORAL - COMPLETE SERIES OF RADIOGRAPHIC IMAGES INTRAORAL - PERIAPICAL FIRST RADIOGRAPHIC IMAGE INTRAORAL - PERIAPICAL EACH ADDITIONAL RADIOGRAPHIC IMAGE INTRAORAL - 0CCLUSAL RADIOGRAPHIC IMAGE EXTRAORAL - FIRST RADIOGRAPHIC IMAGE EXTRAORAL - EACH ADDITIONAL RADIOGRAPHIC IMAGE BITEWING - SINGLE RADIOGRAPHIC IMAGE BITEWINGS - TWO RADIOGRAPHIC IMAGES BITEWINGS - THREE RADIOGRAPHIC IMAGES BITEWINGS - FOUR RADIOGRAPHIC IMAGES VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES POSTERIOR-ANTERIOR OR LATERAL SKULL AND FACIAL BONE SURVEY RADIOGRAPHIC IMAGE SIALOGRAPHY PANORAMIC RADIOGRAPHIC IMAGE CEPHALOMETRIC RADIOGRAPHIC IMAGE ORAL/FACIAL PHOTOGRAPHIC IMAGES DIAGNOSTIC CASTS OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT PROPHYLAXIS-ADULT TOPICAL APPLICATION OF FLUORIDE VARNISH Topical application of fluoride Preventive resin restoration in a moderate to high caries risk patient - permane AMALGAM-ONE SURFACE, PRIMARY OR PERMANENT AMALGAM-TWO SURFACES, PRIMARY OR PERMANENT AMALGAM-THREE SURFACES, PRIMARY OR PERMANENT AMALGAM-FOUR OR MORE SURFACES, PRIMARY OR PERMANENT RESIN-ONE SURFACE, ANTERIOR RESIN-TWO SURFACES, ANTERIOR

2 D2332 D2335 D2390 D2391 D2392 D2393 D2394 D2740 D2751 D2790 D2920 D2931 D2940 D2950 D2954 D3110 D3221 D3310 D3320 D3330 D3331 D3346 D3347 D3348 D4210 D4211 D4240 D4241 D4260 D4261 D4263 D4264 RESIN-THREE SURFACES, ANTERIOR RESIN-FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR) RESIN-BASED COMPOSITE CROWN, ANTERIOR RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR CROWN-PORCELAIN/CERAMIC SUBSTRATE CROWN-PROCELAIN FUSED TO PREDOMINANTLY BASE METAL CROWN-FULL CAST HIGH NOBLE METAL RECEMENT CROWN PREFABRICATED STAINLESS STEEL CROWN-PERMANENT TOOTH PROTECTIVE RESTORATION CORE BUILD-UP, INCLUDING ANY PINS PREFABRICATED POST AND CORE IN ADDITION TO CROWN PULP CAP-DIRECT (EXCLUDING FINAL RESTORATION) PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION) ENDODONTIC THERAPY, BICUSPID TOOTH (EXCLUDING FINAL RESTORATION) ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION) TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-ANTERIOR RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-BICUSPID RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-MOLAR GINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE CONTIGUOUS TEETH OR TOOTH BOUNDED S GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE CONTIGUOUS TEETH OR TOOTH BOUNDED S GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE CONTIGUOUS TEETH OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - FOUR OR MORE CONTIGUOUS TEE OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - ONE TO THREE CONTIGUOUS TEE BONE REPLACEMENT GRAFT - FIRST SITE IN QUADRANT BONE REPLACEMENT GRAFT - EACH ADDITIONAL SITE IN QUADRANT

3 D4266 D4267 D4270 D4273 D4274 D4275 D4276 D4341 D4342 D4355 D4910 D4920 D4999 D5620 D5630 D5640 D7111 D7140 D7210 D7220 D7230 D7240 D7241 D7250 D7260 D7261 D7285 D7286 D7310 D7311 D7320 D7321 GUIDED TISSUE REGENERATION - RESORBABLE BARRIER, PER SITE GUIDED TISSUE REGENERATION - NONRESORBABLE BARRIER, PER SITE, (INCLUDES PEDICLE SOFT TISSUE GRAFT PROCEDURE SUBEPITHELIAL CONNECTIVE TISSUE GRAFT PROCEDURES, PER TOOTH DISTAL OR PROXIMAL WEDGE PROCEDURE (WHEN NOT PERFORMED IN CONJUCTION WITH SOFT TISSUE ALLOGRAFT COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT, PER TOOTH PERIODONTAL SCALING AND ROOT PLANING - FOUR OR MORE TEETH PER QUADRANT PERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS PERIODONTAL MAINTENANCE UNSCHEDULED DRESSING CHANGE (BY SOMEONE OTHER THAN TREATING DENTIST) UNSPECIFIED PERIODONTAL PROCEDURE, BY REPORT REPAIR CAST FRAMEWORK REPAIR OR REPLACE BROKEN CLASP REPLACE BROKEN TEETH-PER TOOTH EXTRACTION, CORONAL REMNANTS - DECIDUOUS TOOTH EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL) SURGICAL REMOVAL OF ERUPTED TOOTH REQUIRING REMOVAL OF BONE AND/OR SECTIONING OF REMOVAL OF IMPACTED TOOTH-SOFT TISSUE REMOVAL OF IMPACTED TOOTH-PARTIALLY BONY REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY, WITH UNUSUAL SURGICAL COMPLICATIONS SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE) ORAL ANTRAL FISTULA CLOSURE PRIMARY CLOSURE OF A SINUS PERFORATION BIOPSY OF ORAL TISSUE - HARD (BONE, TOOTH) BIOPSY OF ORAL TISSUE - SOFT ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH SPAC ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH

4 D7410 EXCISION OF BENIGN LESION UP TO 1.25 CM D7411 EXCISION OF BENIGN LESION GREATER THAN 1.25 CM D7412 EXCISION OF BENIGN LESION, COMPLICATED D7413 EXCISION OF MALIGNANT LESION UP TO 1.25 CM D7414 EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM D7415 EXCISION OF MALIGNANT LESION, COMPLICATED D7440 EXCISION OF MALIGNANT TUMOR-LESION DIAMETER UP TO 1.25 CM D7441 EXCISION OF MALIGNANT TUMOR-LESION DIAMETER GREATER THAN 1.25 CM D7450 REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP T CM D7451 REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN 1.25 CM D7460 REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP TO 1.25 CM D7461 REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN D7465 DESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL METHODS, BY REPORT D7471 REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE) D7490 RADICAL RESECTION OF MAXILLA OR MANDIBLE D7510 INCISION AND DRAINAGE OF ABSCESS-INTRAORAL SOFT TISSUE D7511 INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE - COMPLICATED D7520 INCISION AND DRAINAGE OF ABSCESS-EXTRAORAL SOFT TISSUE D7521 INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE - COMPLICATED D7530 REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE D7540 REMOVAL OF REACTION-PRODUCING FOREIGN BODIES-MUSCULOSKELETAL SYSTEM D7550 PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE D7560 MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT OR FOREIGN BODY D7610 MAXILLA-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESENT) D7620 MAXILLA-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRESENT) D7630 MANDIBLE-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESENT) D7640 MANDIBLE-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRESENT) D7650 MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION D7660 MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION D7670 ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH D7671 ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH D7680 FACIAL BONES-COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL D7710 MAXILLA-OPEN REDUCTION D7720 MAXILLA-CLOSED REDUCTION

5 D7730 D7740 D7750 D7760 D7770 D7771 D7780 D7810 D7820 D7830 D7840 D7850 D7854 D7856 D7858 D7860 D7865 D7870 D7871 D7872 D7873 D7874 D7875 D7876 D7877 D7910 D7911 D7912 D7940 D7941 D7943 D7944 D7945 D7946 D7947 D7948 MANDIBLE-OPEN REDUCTION MANDIBLE-CLOSED REDUCTION MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH FACIAL BONES-COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL OPEN REDUCTION OF DISLOCATION CLOSED REDUCTION OF DISLOCATION MANIPULATION UNDER ANESTHESIA CONDYLECTOMY SURGICAL DISCECTOMY; WITH/WITHOUT IMPLANT SYNOVECTOMY MYOTOMY JOINT RECONSTRUCTION ARTHROTOMY ARTHROPLASTY ARTHROCENTESIS NON-ARTHROSCOPIC LYSIS AND LAVAGE ARTHROSCOPY-DIAGNOSIS, WITH OR WITHOUT BIOPSY ARTHROSCOPY-SURGICAL: LAVAGE AND LYSIS OF ADHESIONS ARTHROSCOPY-SURGICAL: DISC REPOSITIONING AND STABILIZATION ARTHROSCOPY-SURGICAL: SYNOVECTOMY ARTHROSCOPY-SURGICAL: DISCECTOMY ARTHROSCOPY-SURGICAL: DEBRIDEMENT SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM COMPLICATED SUTURE-UP TO 5 CM COMPLICATED SUTURE-GREATER THAN 5 CM OSTEOPLASTY-FOR ORTHOGNATHIC DEFORMITIES OSTEOTOMY - MANDIBULAR RAMI OSTEOTOMY - MANDIBULAR RAMI WITH BONE GRAFT; INCLUDES OBTAINING THE GRAFT OSTEOTOMY-SEGMENTED OR SUBAPICAL OSTEOTOMY-BODY OF MANDIBLE LEFORT I (MAXILLA-TOTAL) LEFORT I (MAXILLA-SEGMENTED) LEFORT II OR LEFORT III (OSTEOPLASTY OF FACIAL BONES FOR MIDFACE HYPOPLASIA OR

6 D7949 LEFORT II OR LEFORT III-WITH BONE GRAFT D7950 OSSEOUS, OSTEOPERIOSTEAL, OR CARTILAGE GRAFT OF THE MANDIBLE OR MAXILLA - AUTOGE D7955 REPAIR OF MAXILLOFACIAL SOFT AND/OR HARD TISSUE DEFECT D7960 FRENULECTOMY - ALSO KNOWN AS FRENECTOMY OR FRENOTOMY - SEPARATE PROCEDURE NOT IN D7963 FRENULOPLASTY D7970 EXCISION OF HYPERPLASTIC TISSUE-PER ARCH D7971 EXCISION OF PERICORONAL GINGIVA D7972 SURGICAL REDUCTION OF FIBROUS TUBEROSITY D7980 SIALOLITHOTOMY D7981 EXCISION OF SALIVARY GLAND, BY REPORT D7982 SIALODOCHOPLASTY D7983 CLOSURE OF SALIVARY FISTULA D7990 EMERGENCY TRACHEOTOMY D7991 CORONOIDECTOMY D9110 PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN-MINOR PROCEDURES D9210 LOCAL ANESTHESIA N0T IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES D9230 INHALATION OF NITROUS OXIDE/ANXIOLYSIS, ANALGESIA D9223 INTRAVENOUS MODERATE (CONSCIOUS) SEDATION/ANALGESIA - EACH 15 MINUTE INCREMENT 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 RE D9410 HOUSE/EXTENDED CARE FACILITY CALL D9420 HOSPITAL OR AMBULATORY SURGICAL CENTER CALL D9430 OFFICE VISIT FOR OBSERVATION (DURING REGULARLY SCHEDULED HOURS) NO OTHER D9440 OFFICE VISIT-AFTER REGULARLY SCHEDULED HOURS D9610 THERAPEUTIC PARENTERAL DRUG, SINGLE ADMINISTRATION D9612 THERAPEUTIC PARENTERAL DRUGS, TWO OR MORE ADMINISTRATIONS, DIFFERENT MEDICATIONS D9930 TREATMENT OF COMPLICATIONS (POSTSURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT D9940 OCCLUSAL GUARDS, BY REPORT D9951 OCCLUSAL ADJUSTMENT-LIMITED

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