Dental Codes- Auth Requirement DCDT DNE Codes

Procedure Need Auth

Category Code Description
(Yes / No)

(Short) periodic oral evaluation - established patient. (Full) An evaluation performed on a patient
of record to determine any changes in the patient’s dental and medical health status since a
DCDT D0120 previous comprehensive or periodic evaluation. This includes an oral cancer evaluation and No
periodontal screening where indicated, and may require interpretation of information acquired
through additional diagnostic procedures. Report additional diagnostic procedures separately.
(Short) limited oral evaluation - problem focused. (Full) An evaluation limited to a specific oral
health problem or complaint. This may require interpretation of information acquired through
additional diagnostic procedures. Report additional diagnostic procedures separately. Definitive
DCDT D0140 No
procedures may be required on the same date as the evaluation. Typically, patients receiving this
type of evaluation present with a specific problem and/or dental emergencies, trauma, acute
infections, etc.
(Short) oral evaluation for a patient under three years of age and counseling with primary
caregiver. (Full) Diagnostic services performed for a child under the age of three, preferably within
the first six months of the eruption of the first primary tooth, including recording the oral and
DCDT D0145 No
physical health history, evaluation of caries susceptibility, development of an appropriate preventive
oral health regimen and communication with and counseling of the child’s parent, legal guardian
and/or primary caregiver.
(Short) comprehensive oral evaluation - new or established patient. (Full) Used by a general
dentist and/or a specialist when evaluating a patient comprehensively. This applies to new
patients; established patients who have had a significant change in health conditions or other
unusual circumstances, by report, or established patients who have been absent from active
treatment for three or more years. It is a thorough evaluation and recording of the extraoral and
intraoral hard and soft tissues. It may require interpretation of information acquired through
DCDT D0150 No
additional diagnostic procedures. Additional diagnostic procedures should be reported separately.
This includes an evaluation for oral cancer where indicated, the evaluation and recording of the
patient’s dental and medical history and a general health assessment. It may include the evaluation
and recording of dental caries, missing or unerupted teeth, restorations, existing prostheses,
occlusal relationships, periodontal conditions (including periodontal screening and/or charting), hard
and soft tissue anomalies, etc.

(Short) detailed and extensive oral evaluation - problem focused, by report. (Full) A detailed and
extensive problem focused evaluation entails extensive diagnostic and cognitive modalities based
on the findings of a comprehensive oral evaluation. Integration of more extensive diagnostic
modalities to develop a treatment plan for a specific problem is required. The condition requiring
DCDT D0160 No
this type of evaluation should be described and documented. Examples of conditions requiring this
type of evaluation may include dentofacial anomalies, complicated perio-prosthetic conditions,
complex temporomandibular dysfunction, facial pain of unknown origin, conditions requiring multi-
disciplinary consultation, etc.

(Short) re-evaluation - limited, problem focused (established patient; not post-operative visit).
(Full) Assessing the status of a previously existing condition. For example: - a traumatic injury
DCDT D0170 No
where no treatment was rendered but patient needs follow-up monitoring; - evaluation for
undiagnosed continuing pain; - soft tissue lesion requiring follow-up evaluation.

(Short) comprehensive periodontal evaluation - new or established patient. (Full) This procedure is
indicated for patients showing signs or symptoms of periodontal disease and for patients with risk
factors such as smoking or diabetes. It includes evaluation of periodontal conditions, probing and
DCDT D0180 No
charting, evaluation and recording of the patient's dental and medical history and general health
assessment. It may include the evaluation and recording of dental caries, missing or unerupted
teeth, restorations, occlusal relationships and oral cancer evaluation

(Short) intraoral - complete series (including bitewings) . (Full) A radiographic survey of the whole
DCDT D0210 mouth, usually consisting of 14-22 periapical and posterior bitewing images intended to display the No
crowns and roots of all teeth, periapical areas and alveolar bone.

DCDT D0220 (Short) intraoral - periapical first film. (Full) No

DCDT D0230 (Short) intraoral - periapical each additional film. (Full) No

DCDT D0240 (Short) intraoral - occlusal film. (Full) No

DCDT D0250 (Short) extraoral - first film. (Full) No

DCDT D0260 (Short) extraoral - each additional film. (Full) No

DCDT D0270 (Short) bitewing - single film. (Full) No

DCDT D0272 (Short) bitewings - two films. (Full) No

DCDT D0273 (Short) bitewings - three films. (Full) No

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 DCDT D0274 (Short) bitewings - four films. (Full) No

(Short) vertical bitewings - 7 to 8 films. (Full) This does not constitute a full mouth intraoral
DCDT D0277 No
radiographic series.

DCDT D0290 (Short) posterior-anterior or lateral skull and facial bone survey film. (Full) No

DCDT D0310 (Short) sialography. (Full) No

DCDT D0320 (Short) temporomandibular joint arthrogram, including injection. (Full) No

DCDT D0321 (Short) other temporomandibular joint films, by report. (Full) No

DCDT D0322 (Short) tomographic survey. (Full) No

DCDT D0330 (Short) panoramic film. (Full) No

DCDT D0340 (Short) cephalometric film. (Full) No

(Short) oral/facial photographic images. (Full) This includes photographic images, including those
DCDT D0350 obtained by intraoral and extraoral cameras, excluding radiographic images. These photographic No
images should be a part of the patient’s clinical record

DCDT D0360 (Short) cone beam ct – craniofacial data capture. (Full) Includes axial, coronal and sagittal data. Yes

(Short) cone beam – two-dimensional image reconstruction using existing data, includes multiple
DCDT D0362 Yes
images. (Full)

(Short) cone beam – three-dimensional image reconstruction using existing data, includes multiple
DCDT D0363 Yes
images. (Full)

DCDT D0415 (Short) collection of microorganisms for culture and sensitivity . (Full) No

DCDT D0416 (Short) viral culture. (Full) A diagnostic test to identify viral organisms, most often herpes virus. No

DCDT D0417 (Short) collection and preparation of saliva sample for laboratory diagnostic testing. (Full) No

(Short) analysis of saliva sample. (Full) Chemical or biological analysis of saliva sample for
DCDT D0418 No
diagnostic purposes.

(Short) genetic test for susceptibility to oral diseases. (Full) Sample collection for the purpose of
DCDT D0421 certified laboratory analysis to detect specific genetic variations associated with increased No
susceptibility for oral diseases such as severe periodontal disease.

DCDT D0425 (Short) caries susceptibility tests. (Full) Not to be used for carious dentin staining. No

(Short) adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including
DCDT D0431 No
premalignant and malignant lesions, not to include cytology or biopsy procedures . (Full)

(Short) pulp vitality tests . (Full) Includes multiple teeth and contra lateral comparison(s), as
DCDT D0460 No
indicated.

DCDT D0470 (Short) diagnostic casts. (Full) Also known as diagnostic models or study models. No

(Short) accession of tissue, gross examination, preparation and transmission of written report.
DCDT D0472 No
(Full) To be used in reporting architecturally intact tissue obtained by invasive means.

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 (Short) accession of tissue, gross and microscopic examination, preparation and transmission of
DCDT D0473 written report. (Full) To be used in reporting architecturally intact tissue obtained by invasive No
means.

(Short) accession of tissue, gross and microscopic examination, including assessment of surgical
DCDT D0474 margins for presence of disease, preparation and transmission of written report. (Full) To be used No
in reporting architecturally intact tissue obtained by invasive means.

(Short) accession of exfoliative cytologic smears, microscopic examination, preparation and

DCDT D0480 transmission of written report. (Full) To be used in reporting disaggregated, non-transepithelial cell No
cytology sample via mild scraping of the oral mucosa.

(Short) laboratory accession of transepithelial cytologic sample, microscopic examination,

DCDT D0486 preparation and transmission of written report. (Full) Analysis, and written report of findings, of No
cytologic sample of disaggregated transepithelial cells.

(Short) decalcification procedure. (Full) Procedure in which hard tissue is processed in order to
DCDT D0475 No
allow sectioning and subsequent microscopic examination.

(Short) special stains for microorganisms. (Full) Procedure in which additional stains are applied to
DCDT D0476 No
biopsy or surgical specimen in order to identify microorganisms.

(Short) special stains, not for microorganisms. (Full) Procedure in which additional stains are
DCDT D0477 applied to a biopsy or surgical specimen in order to identify such things as melanin, mucin, iron, No
glycogen, etc.

(Short) immunohistochemical stains. (Full) A procedure in which specific antibody based reagents
DCDT D0478 No
are applied to tissue samples in order to facilitate diagnosis.

(Short) tissue in-situ hybridization, including interpretation. (Full) A procedure which allows for the
DCDT D0479 identification of nucleic acids, DNA and RNA, in the tissue sample in order to aid in the diagnosis of No
microorganisms and tumors.

(Short) electron microscopy - diagnostic. (Full) An extreme high magnification diagnostic

DCDT D0481 procedure that enables identification of cell components and microorganisms that are otherwise not No
identifiable under light microscopy.

(Short) direct immunofluorescence. (Full) A technique used to identify immunoreactants which are
DCDT D0482 No
localized to the patient's skin or mucous membranes.

(Short) indirect immunofluorescence. (Full) A technique used to identify circulating

DCDT D0483 No
immunoreactants.

(Short) consultation on slides prepared elsewhere. (Full) A service provided in which microscopic
slides of a biopsy specimen prepared at another laboratory are evaluated to aid in the diagnosis of
DCDT D0484 No
a difficult case or to offer a consultative opinion at the patient's request. The findings are delivered
by written report.
(Short) consultation, including preparation of slides from biopsy material supplied by referring
source. (Full) A service that requires the consulting pathologist to prepare the slides as well as
DCDT D0485 No
render a written report. The slides are evaluated to aid in the diagnosis of a difficult case or to
offer a consultative opinion at the patient's request.

DCDT D0502 (Short) other oral pathology procedures, by report. (Full) No

(Short) unspecified diagnostic procedure, by report. (Full) Used for procedure that is not
DCDT D0999 No
adequately described by a code. Describe procedure.

(Short) prophylaxis - adult. (Full) Removal of plaque, calculus and stains from the tooth structures
DCDT D1110 No
in the permanent and transitional dentition. It is intended to control local irritational factors.

(Short) prophylaxis - child. (Full) Removal of plaque, calculus and stains from the tooth structures
DCDT D1120 No
in the primary and transitional dentition. It is intended to control local irritational factors.

DCDT D1203 (Short) topical application of fluoride - child. (Full) No

DCDT D1204 (Short) topical application of fluoride - adult. (Full) No

(Short) topical fluoride varnish; therapeutic application for moderate to high caries risk patients.
DCDT D1206 (Full) Application of topical fluoride varnish, delivered in a single visit and involving the entire oral No
cavity. Not to be used for desensitization.

(Short) nutritional counseling for control of dental disease. (Full) Counseling on food selection and
DCDT D1310 No
dietary habits as a part of treatment and control of periodontal disease and caries.

(Short) tobacco counseling for the control and prevention of oral disease. (Full) Tobacco prevention
DCDT D1320 and cessation services reduce patient risks of developing tobacco-related oral diseases and No
conditions and improves prognosis for certain dental therapies.

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 (Short) oral hygiene instructions. (Full) This may include instructions for home care. Examples
DCDT D1330 No
include tooth brushing technique, flossing, use of special oral hygiene aids.

(Short) sealant - per tooth. (Full) Mechanically and/or chemically prepared enamel surface sealed
DCDT D1351 No
to prevent decay.

(Short) preventive resin restoration in a moderate to high caries risk patient – permanent tooth.
DCDT D1352 (Full) Conservative restoration of an active cavitated lesion in a pit or fissure that does not extend No
into dentin; includes placement of a sealant in any radiating non-carious fissures or pits.

DCDT D1510 (Short) space maintainer - fixed - unilateral. (Full) No

DCDT D1515 (Short) space maintainer - fixed - bilateral. (Full) No

DCDT D1520 (Short) space maintainer - removable - unilateral. (Full) No

DCDT D1525 (Short) space maintainer - removable - bilateral. (Full) No

DCDT D1550 (Short) re-cementation of space maintainer. (Full) No

(Short) removal of fixed space maintainer. (Full) Procedure delivered by dentist who did not
DCDT D1555 originally place the appliance, or by the practice where the appliance was originally delivered to the No
patient.

DCDT D2140 (Short) amalgam - one surface, primary or permanent. (Full) No

DCDT D2150 (Short) amalgam - two surfaces, primary or permanent. (Full) No

DCDT D2160 (Short) amalgam - three surfaces, primary or permanent. (Full) No

DCDT D2161 (Short) amalgam - four or more surfaces, primary or permanent. (Full) No

DCDT D2330 (Short) resin-based composite - one surface, anterior. (Full) No

DCDT D2331 (Short) resin-based composite - two surfaces, anterior. (Full) No

DCDT D2332 (Short) resin-based composite - three surfaces, anterior. (Full) No

(Short) resin-based composite - four or more surfaces or involving incisal angle (anterior). (Full)
DCDT D2335 Incisal angle to be defined as one of the angles formed by the junction of the incisal and the mesial No
or distal surface of an anterior tooth.

DCDT D2390 (Short) resin-based composite crown, anterior. (Full) Full resin-based composite coverage of tooth. No

(Short) resin-based composite - one surface, posterior. (Full) Used to restore a carious lesion into
DCDT D2391 No
the dentin or a deeply eroded area into the dentin. Not a preventive procedure.

DCDT D2392 (Short) resin-based composite - two surfaces, posterior. (Full) No

DCDT D2393 (Short) resin-based composite - three surfaces, posterior. (Full) No

DCDT D2394 (Short) resin-based composite - four or more surfaces, posterior. (Full) No

DCDT D2410 (Short) gold foil - one surface. (Full) No

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 DCDT D2420 (Short) gold foil - two surfaces. (Full) No

DCDT D2430 (Short) gold foil - three surfaces. (Full) No

DCDT D2510 (Short) inlay - metallic - one surface. (Full) Yes

DCDT D2520 (Short) inlay - metallic - two surfaces. (Full) Yes

DCDT D2530 (Short) inlay - metallic - three or more surfaces. (Full) Yes

DCDT D2542 (Short) onlay - metallic-two surfaces. (Full) Yes

DCDT D2543 (Short) onlay - metallic-three surfaces. (Full) Yes

DCDT D2544 (Short) onlay - metallic-four or more surfaces. (Full) Yes

DCDT D2610 (Short) inlay - porcelain/ceramic - one surface. (Full) Yes

DCDT D2620 (Short) inlay - porcelain/ceramic - two surfaces . (Full) Yes

DCDT D2630 (Short) inlay - porcelain/ceramic - three or more surfaces. (Full) Yes

DCDT D2642 (Short) onlay - porcelain/ceramic - two surfaces. (Full) Yes

DCDT D2643 (Short) onlay - porcelain/ceramic - three surfaces. (Full) Yes

DCDT D2644 (Short) onlay - porcelain/ceramic - four or more surfaces. (Full) Yes

DCDT D2650 (Short) inlay - resin-based composite - one surface . (Full) No

DCDT D2651 (Short) inlay - resin-based composite - two surfaces . (Full) No

DCDT D2652 (Short) inlay - resin-based composite - three or more surfaces . (Full) No

DCDT D2662 (Short) onlay - resin-based composite - two surfaces . (Full) No

DCDT D2663 (Short) onlay - resin-based composite - three surfaces . (Full) No

DCDT D2664 (Short) onlay - resin-based composite - four or more surfaces . (Full) No

(Short) crown - resin-based composite (indirect). (Full) Unfilled or non-reinforced resin crowns
DCDT D2710 No
should be reported using D2999.

(Short) crown - ¾ resin-based composite (indirect). (Full) This code does not include facial
DCDT D2712 No
veneers.

DCDT D2720 (Short) crown - resin with high noble metal. (Full) Yes

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 DCDT D2721 (Short) crown - resin with predominantly base metal. (Full) Yes

DCDT D2722 (Short) crown - resin with noble metal. (Full) Yes

DCDT D2740 (Short) crown - porcelain/ceramic substrate. (Full) Yes

DCDT D2750 (Short) crown - porcelain fused to high noble metal. (Full) Yes

DCDT D2751 (Short) crown - porcelain fused to predominantly base metal. (Full) Yes

DCDT D2752 (Short) crown - porcelain fused to noble metal. (Full) Yes

DCDT D2780 (Short) crown - 3/4 cast high noble metal. (Full) Yes

DCDT D2781 (Short) crown - 3/4 cast predominantly base metal . (Full) Yes

DCDT D2782 (Short) crown - 3/4 cast noble metal . (Full) Yes

DCDT D2783 (Short) crown - 3/4 porcelain/ceramic . (Full) This code does not include facial veneers. Yes

DCDT D2790 (Short) crown - full cast high noble metal. (Full) Yes

DCDT D2791 (Short) crown - full cast predominantly base metal. (Full) Yes

DCDT D2792 (Short) crown - full cast noble metal. (Full) Yes

DCDT D2794 (Short) crown - titanium. (Full) Yes

(Short) provisional crown. (Full) Crown utilized as an interim restoration of at least six months
duration during restorative treatment to allow adequate time for healing or completion of other
DCDT D2799 procedures. This includes, but is not limited to changing vertical dimension, completing periodontal Yes
therapy or cracked-tooth syndrome. This is not to be used as a temporary crown for a routine
prosthetic restoration.

DCDT D2910 (Short) recement inlay, onlay, or partial coverage restoration. (Full) No

DCDT D2915 (Short) recement cast or prefabricated post and core. (Full) No

DCDT D2920 (Short) recement crown. (Full) No

DCDT D2930 (Short) prefabricated stainless steel crown - primary tooth. (Full) No

DCDT D2931 (Short) prefabricated stainless steel crown - permanent tooth. (Full) No

DCDT D2932 (Short) prefabricated resin crown. (Full) No

(Short) prefabricated stainless steel crown with resin window. (Full) Open-face stainless steel
DCDT D2933 No
crown with aesthetic resin facing or veneer.

(Short) prefabricated esthetic coated stainless steel crown - primary tooth. (Full) Stainless steel
DCDT D2934 No
primary crown with exterior esthetic coating.

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 (Short) protective restoration. (Full) Direct placement of a temporary restorative material to
protect tooth and/or tissue form. This procedure may be used to relieve pain, promote healing, or
DCDT D2940 No
prevent further deterioration. Not to be used for endodontic access closure, or as a base or liner
under a restoration.
(Short) core buildup, including any pins. (Full) Refers to building up of anatomical crown when
restorative crown will be placed, whether or not pins are used. A material is placed in the tooth
DCDT D2950 preparation for a crown when there is insufficient tooth strength and retention for the crown No
procedure. This should not be reported when the procedure only involves a filler to eliminate any
undercut, box form, or concave irregularity in the preparation.

DCDT D2951 (Short) pin retention - per tooth, in addition to restoration. (Full) No

(Short) post and core in addition to crown, indirectly fabricated. (Full) Post and core are custom
DCDT D2952 No
fabricated as a single unit.

DCDT D2953 (Short) each additional indirectly fabricated post - same tooth. (Full) To be used with D2952. No

(Short) prefabricated post and core in addition to crown. (Full) Core is built around a prefabricated
DCDT D2954 No
post. This procedure includes the core material.

(Short) post removal (not in conjunction with endodontic therapy). (Full) For removal of posts
DCDT D2955 (e.g., fractured posts) not to be used in conjunction with endodontic retreatment (D3346, D3347, No
D3348).

DCDT D2957 (Short) each additional prefabricated post - same tooth. (Full) To be used with D2954. No

(Short) labial veneer (resin laminate) - chairside. (Full) Refers to labial/facial direct resin bonded
DCDT D2960 No
veneers.

(Short) labial veneer (resin laminate) - laboratory. (Full) Refers to labial/facial indirect resin
DCDT D2961 No
bonded veneers.

(Short) labial veneer (porcelain laminate) - laboratory. (Full) Refers also to facial veneers that
DCDT D2962 extend interproximally and/or cover the incisal edge. Porcelain/ceramic veneers presently include Yes
all ceramic and porcelain veneers.

(Short) temporary crown (fractured tooth). (Full) Usually a preformed artificial crown, which is
DCDT D2970 fitted over a damaged tooth as an immediate protective device. This is not to be used as No
temporization during crown fabrication.

(Short) additional procedures to construct new crown under existing partial denture framework.
DCDT D2971 Yes
(Full) To be reported in addition to a crown code.

(Short) coping. (Full) A thin covering of the remaining portion of a tooth, usually fabricated of
DCDT D2975 Yes
metal and devoid of anatomic contour. This is to be used as a definitive restoration.

DCDT D2980 (Short) crown repair, by report. (Full) Includes removal of crown, if necessary. Describe procedure. No

(Short) unspecified restorative procedure, by report. (Full) Use for procedure that is not adequately
DCDT D2999 No
described by a code. Describe procedure.

(Short) pulp cap - direct (excluding final restoration). (Full) Procedure in which the exposed pulp is
DCDT D3110 No
covered with a dressing or cement that protects the pulp and promotes healing and repair.

(Short) pulp cap - indirect (excluding final restoration). (Full) Procedure in which the nearly
exposed pulp is covered with a protective dressing to protect the pulp from additional injury and to
DCDT D3120 No
promote healing and repair via formation of secondary dentin. This code is not to be used for bases
and liners when all caries has been removed.
(Short) therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the
dentinocemental junction and application of medicament. (Full) Pulpotomy is the surgical removal
of a portion of the pulp with the aim of maintaining the vitality of the remaining portion by means
DCDT D3220 of an adequate dressing. No
– To be performed on primary or permanent teeth.
– This is not to be construed as the first stage of root canal therapy.
– Not to be used for apexogenesis.
(Short) pulpal debridement, primary and permanent teeth. (Full) Pulpal debridement for the relief
DCDT D3221 of acute pain prior to conventional root canal therapy. This procedure is not to be used when No
endodontic treatment is completed on the same day.
(Short) partial pulpotomy for apexogenesis - permanent tooth with incomplete root development.
(Full) Removal of a portion of the pulp and application of a medicament with the aim of maintaining
DCDT D3222 No
the vitality of the remaining portion to encourage continued physiological development and
formation of the root. This procedure is not to be construed as the first stage of root canal therapy.

(Short) pulpal therapy (resorbable filling) - anterior, primary tooth (excluding final restoration) .
DCDT D3230 No
(Full) Primary incisors and cuspids.

(Short) pulpal therapy (resorbable filling) - posterior, primary tooth (excluding final restoration).
DCDT D3240 No
(Full) Primary first and second molars.

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 DCDT D3310 (Short) endodontic therapy, anterior tooth (excluding final restoration). (Full) No

DCDT D3320 (Short) endodontic therapy, bicuspid tooth (excluding final restoration). (Full) No

DCDT D3330 (Short) endodontic therapy, molar (excluding final restoration). (Full) No

(Short) treatment of root canal obstruction; non-surgical access. (Full) In lieu of surgery, the
formation of a pathway to achieve an apical seal without surgical intervention because of a non-
DCDT D3331 No
negotiable root canal blocked by foreign bodies, including but not limited to separated instruments,
broken posts or calcification of 50% or more of the length of the tooth root.

(Short) incomplete endodontic therapy; inoperable, unrestorable or fractured tooth. (Full)

DCDT D3332 Considerable time is necessary to determine diagnosis and/or provide initial treatment before the No
fracture makes the tooth unretainable.

(Short) internal root repair of perforation defects. (Full) Non-surgical seal of perforation caused by
DCDT D3333 No
resorption and/or decay but not iatrogenic by provider filing claim.

DCDT D3346 (Short) retreatment of previous root canal therapy - anterior. (Full) No

DCDT D3347 (Short) retreatment of previous root canal therapy - bicuspid. (Full) No

DCDT D3348 (Short) retreatment of previous root canal therapy - molar. (Full) No

(Short) apexification/recalcification/pulpal regeneration – initial visit (apical closure/calcific repair of

perforations, root resorption, pulp space disinfection, etc.). (Full) Includes opening tooth,
DCDT D3351 No
preparation of canal spaces, first placement of medication and necessary radiographs. (This
procedure may include first phase of complete root canal therapy.)
(Short) apexification/recalcification/pulpal regeneration - interim medication replacement (apical
closure/calcific repair of perforations, root resorption, pulp space disinfection, etc.). (Full) For visits
DCDT D3352 No
in which the intra-canal medication is replaced with new medication and necessary radiographs.
There may be several of these visits.
(Short) apexification/recalcification - final visit (includes completed root canal therapy - apical
closure/calcific repair of perforations, root resorption, etc.). (Full) Includes removal of intra-canal
DCDT D3353 No
medication and procedures necessary to place final root canal filling material including necessary
radiographs. (This procedure includes last phase of complete root canal therapy.)

(Short) pulpal regeneration – (completion of regenerative treatment in an immature permanent

tooth with a necrotic pulp); does not include final restoration. (Full) Includes removal of intra-canal
DCDT D3354 medication and procedures necessary to regenerate continued root development and necessary No
radiographs. This procedure includes placement of a seal at the coronal portion of the root canal
system. Conventional root canal treatment is not performed.

(Short) apicoectomy/periradicular surgery - anterior. (Full) For surgery on root of anterior tooth.
DCDT D3410 No
Does not include placement of retrograde filling material.

(Short) apicoectomy/periradicular surgery - bicuspid (first root). (Full) For surgery on one root of a
DCDT D3421 bicuspid. Does not include placement of retrograde filling material. If more than one root is No
treated, see D3426.

(Short) apicoectomy/periradicular surgery - molar (first root). (Full) For surgery on one root of a
DCDT D3425 molar tooth. Does not include placement of retrograde filling material. If more than one root is No
treated, see D3426.

(Short) apicoectomy/periradicular surgery (each additional root). (Full) Typically used for bicuspids
DCDT D3426 and molar surgeries when more than one root is treated during the same procedure. This does not No
include retrograde filling material placement.

(Short) retrograde filling - per root. (Full) For placement of retrograde filling material during
DCDT D3430 periradicular surgery procedures. If more than one filling is placed in one root - report as D3999 No
and describe.

(Short) root amputation - per root. (Full) Root resection of a multi-rooted tooth while leaving the
DCDT D3450 No
crown. If the crown is sectioned, see D3920.

(Short) endodontic endosseous implant. (Full) Placement of implant material, which extends from
DCDT D3460 No
a pulpal space into the bone beyond the end of the root.

(Short) intentional reimplantation (including necessary splinting). (Full) For the intentional
DCDT D3470 removal, inspection and treatment of the root and replacement of a tooth into its own socket. T his No
does not include necessary retrograde filling material placement.

DCDT D3910 (Short) surgical procedure for isolation of tooth with rubber dam. (Full) No

(Short) hemisection (including any root removal), not including root canal therapy. (Full) Includes
DCDT D3920 separation of a multi-rooted tooth into separate sections containing the root and the overlying No
portion of the crown. It may also include the removal of one or more of those sections.

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 (Short) canal preparation and fitting of preformed dowel or post. (Full) Should not be reported in
DCDT D3950 No
conjunction with D2952, D2953, D2954 or D2957 by the same practitioner.

(Short) unspecified endodontic procedure, by report. (Full) Used for procedure that is not
DCDT D3999 No
adequately described by a code. Describe procedure.
(Short) gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per
quadrant. (Full) Involves the excision of the soft tissue wall of the periodontal pocket by either an
external or an internal bevel. It is performed to eliminate suprabony pockets after adequate initial
DCDT D4210 No
preparation, to allow access for restorative dentistry in the presence of suprabony pockets, or to
restore normal architecture when gingival enlargements or asymmetrical or unaesthetic topography
is evident with normal bony configuration.

(Short) gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per
quadrant. (Full) Involves the excision of the soft tissue wall of the periodontal pocket by either an
external or an internal bevel. It is performed to eliminate suprabony pockets after adequate initial
DCDT D4211 No
preparation, to allow access for restorative dentistry in the presence of suprabony pockets, or to
restore normal architecture when gingival enlargements or asymmetrical or unaesthetic topography
is evident with normal bony configuration

(Short) anatomical crown exposure - four or more contiguous teeth per quadrant. (Full) This
DCDT D4230 procedure is utilized in an otherwise periodontally healthy area to remove enlarged gingival tissue No
and supporting bone (ostectomy) to provide an anatomically correct gingival relationship.

(Short) anatomical crown exposure - one to three teeth per quadrant. (Full) This procedure is
DCDT D4231 utilized in an otherwise periodontally healthy area to remove enlarged gingival tissue and No
supporting bone (ostectomy) to provide an anatomically correct gingival relationship.

(Short) gingival flap procedure, including root planing - four or more contiguous teeth or tooth
bounded spaces per quadrant. (Full) A soft tissue flap is reflected or resected to allow debridement
of the root surface and the removal of granulation tissue. Osseous recontouring is not
accomplished in conjunction with this procedure. May include open flap curettage, reverse bevel
DCDT D4240 flap surgery, modified Kirkland flap procedure, and modified Widman surgery. This procedure is No
performed in the presence of moderate to deep probing depths, loss of attachment, need to
maintain esthetics, need for increased access to the root surface and alveolar bone, or to determine
the presence of a cracked tooth, fractured root, or external root resorption. Other procedures may
be required concurrent to D4240 and should be reported separately using their own unique codes

(Short) gingival flap procedure, including root planing - one to three contiguous teeth or tooth
bounded spaces per quadrant. (Full) A soft tissue flap is reflected or resected to allow debridement
of the root surface and the removal of granulation tissue. Osseous recontouring is not
accomplished in conjunction with this procedure. May include open flap curettage, reverse bevel
DCDT D4241 flap surgery, modified Kirkland flap procedure, and modified Widman surgery. This procedure is No
performed in the presence of moderate to deep probing depths, loss of attachment, need to
maintain esthetics, need for increased access to the root surface and alveolar bone, or to determine
the presence of a cracked tooth, fractured root, or external root resorption. Other procedures may
be required concurrent to D4241 and should be reported separately using their own unique codes.
(Short) apically positioned flap. (Full) Procedure is used to preserve keratinized gingiva in
conjunction with osseous resection and second stage implant procedure. Procedure may also be
DCDT D4245 No
used to preserve keratinized/attached gingiva during surgical exposure of labially impacted teeth,
and may be used during treatment of peri-implantitis.
(Short) clinical crown lengthening - hard tissue. (Full) This procedure is employed to allow
restorative procedure or crown with little or no tooth structure exposed to the oral cavity. Crown
DCDT D4249 lengthening requires reflection of a flap and is performed in a healthy periodontal environment, as No
opposed to osseous surgery, which is performed in the presence of periodontal disease. Where
there are adjacent teeth, the flap design may involve a larger surgical area.

(Short) osseous surgery (including flap entry and closure) - four or more contiguous teeth or tooth
bounded spaces per quadrant. (Full) This procedure modifies the bony support of the teeth by
DCDT D4260 reshaping the alveolar process to achieve a more physiologic form. This may include the removal of No
supporting bone (ostectomy) and/or non-supporting bone (osteoplasty). Other procedures may be
required concurrent to D4260 and should be reported using their own unique codes

(Short) osseous surgery (including flap entry and closure) - one to three contiguous teeth or tooth
bounded spaces per quadrant. (Full) This procedure modifies the bony support of the teeth by
DCDT D4261 reshaping the alveolar process to achieve a more physiologic form. This may include the removal of No
supporting bone (ostectomy) and/or non-supporting bone (osteoplasty). Other procedures may be
required concurrent to D4261 and should be reported using their own unique codes.

(Short) bone replacement graft - first site in quadrant. (Full) This procedure involves the use of
osseous autografts, osseous allografts, or non-osseous grafts to stimulate periodontal regeneration
when the disease process has led to a deformity of the bone. This procedure does not include flap
DCDT D4263 Yes
entry and closure, wound debridement, osseous contouring, or the placement of biologic materials
to aid in osseous tissue regeneration or barrier membranes. Other separate procedures may be
required concurrent to D4263 and should be reported using their own unique codes.

(Short) bone replacement graft - each additional site in quadrant. (Full) This procedure involves
the use of osseous autografts, osseous allografts, or non-osseous grafts to stimulate periodontal
regeneration when the disease process has led to a deformity of the bone. This procedure does not
DCDT D4264 Yes
include flap entry and closure, wound debridement, osseous contouring, or the placement of
biologic materials to aid in osseous tissue regeneration or barrier membranes. This code is used if
performed concurrently with D4263 and allows reporting of the exact number of sites involved.
(Short) biologic materials to aid in soft and osseous tissue regeneration. (Full) Biologic materials
may be used alone or with other regenerative substrates such as bone and barrier membranes,
DCDT D4265 depending upon their formulation and the presentation of the periodontal defect. This procedure Yes
does not include surgical entry and closure, wound debridement, osseous contouring, or the
placement of graft materials and/or barrier membranes. Other separate procedures may be
(Short) guided tissue regeneration - resorbable barrier, per site. (Full) A membrane is placed over
the root surfaces or defect area following surgical exposure and debridement. The mucoperiosteal
flaps are then adapted over the membrane and sutured. The membrane is placed to exclude
epithelium and gingival connective tissue from the healing wound. This procedure may require
subsequent surgical procedures to correct the gingival contours. Guided tissue regeneration may
DCDT D4266 Yes
also be carried out in conjunction with bone replacement grafts or to correct deformities resulting
from inadequate faciolingual bone width in an edentulous area. When guided tissue regeneration is
used in association with a tooth, each site on a specific tooth should be reported separately. Other
separate procedures may be required concurrent to D4266 and should be reported using their own
unique codes.

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 (Short) guided tissue regeneration - nonresorbable barrier, per site (includes membrane removal).
(Full) This procedure is used to regenerate lost or injured periodontal tissue by directing differential
tissue responses. A membrane is placed over the root surfaces or defect area following surgical
exposure and debridement. The mucoperiosteal flaps are then adapted over the membrane and
sutured. This procedure does not include flap entry and closure, wound debridement, osseous
contouring, bone replacement grafts, or the placement of biologic materials to aid in osseous tissue
regeneration. The membrane is placed to exclude epithelium and gingival connective tissue from
DCDT D4267 Yes
the healing wound. This procedure requires subsequent surgical procedures to remove the
membranes and/or to correct the gingival contours. Guided tissue regeneration may be used in
conjunction with bone replacement grafts or to correct deformities resulting from inadequate
faciolingual bone width in an edentulous area. When guided tissue regeneration is used in
association with a tooth, each site on a specific tooth should be reported separately with this code.
When no tooth is present, each site should be reported separately. Other separate procedures may
be required concurrent to D4267 and should be reported using their own unique codes.

(Short) surgical revision procedure, per tooth. (Full) This procedure is to refine the results of a
previously provided surgical procedure. This may require a surgical procedure to modify the
DCDT D4268 Yes
irregular contours of hard or soft tissue. A mucoperiosteal flap may be elevated to allow access to
reshape alveolar bone. The flaps are replaced or repositioned and sutured.
(Short) pedicle soft tissue graft procedure. (Full) A pedicle flap of gingiva can be raised from an
edentulous ridge, adjacent teeth, or from the existing gingiva on the tooth and moved laterally or
DCDT D4270 Yes
coronally to replace alveolar mucosa as marginal tissue. The procedure can be used to cover an
exposed root or to eliminate a gingival defect if the root is not too prominent in the arch.
(Short) free soft tissue graft procedure (including donor site surgery). (Full) Gingival or
masticatory mucosa is grafted to create or augment the gingiva at another site, with or without root
DCDT D4271 Yes
coverage. This graft may also be used to eliminate the pull of frena and muscle attachments, to
extend the vestibular fornix, and to correct localized gingival recession.
(Short) subepithelial connective tissue graft procedures, per tooth. (Full) This procedure is
performed to create or augment gingiva, to obtain root coverage to eliminate sensitivity and to
DCDT D4273 prevent root caries, to eliminate frenum pull, to extend the vestibular fornix, to augment collapsed Yes
ridges, to provide an adequate gingival interface with a restoration or to cover bone or ridge
regeneration sites when adequate gingival tissues are not available for effective closure. There are
(Short) distal or proximal wedge procedure (when not performed in conjunction with surgical
procedures in the same anatomical area). (Full) This procedure is performed in an edentulous area
DCDT D4274 Yes
adjacent to a periodontally involved tooth. Gingival incisions are utilized to allow removal of a tissue
wedge to gain access and correct the underlying osseous defect and to permit close flap adaptation.
(Short) soft tissue allograft . (Full) Procedure is performed to create or augment the gingiva, with
or without root coverage. This may be used to eliminate the pull of the frena and muscle
DCDT D4275 Yes
attachments, to extend the vestibular fornix, and correct localized gingival recession. There is no
donor site.

(Short) combined connective tissue and double pedicle graft, per tooth. (Full) Advanced gingival
DCDT D4276 recession often cannot be corrected with a single procedure. Combined tissue grafting procedures Yes
are needed to achieve the desired outcome.

(Short) provisional splinting - intracoronal. (Full) This is an interim stabilization of mobile teeth. A
DCDT D4320 Yes
variety of methods and appliances may be employed for this purpose. Identify the teeth involved.

(Short) provisional splinting - extracoronal. (Full) This is an interim stabilization of mobile teeth. A
DCDT D4321 No
variety of methods and appliances may be employed for this purpose. Identify the teeth involved.

(Short) periodontal scaling and root planing - four or more teeth per quadrant. (Full) This
procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque
and calculus from these surfaces. It is indicated for patients with periodontal disease and is
therapeutic, not prophylactic, in nature. Root planing is the definitive procedure designed for the
DCDT D4341 No
removal of cementum and dentin that is rough, and/or permeated by calculus or contaminated with
toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used as a
definitive treatment in some stages of periodontal disease and/or as a part of pre-surgical
procedures in others.
(Short) periodontal scaling and root planing - one to three teeth per quadrant. (Full) This
procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque
and calculus from these surfaces. It is indicated for patients with periodontal disease and is
therapeutic, not prophylactic, in nature. Root planing is the definitive procedure designed for the
DCDT D4342 No
removal of cementum and dentin that is rough, and/or permeated by calculus or contaminated with
toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used as a
definitive treatment in some stages of periodontal disease and/or as a part of pre-surgical
procedures in others.
(Short) full mouth debridement to enable comprehensive evaluation and diagnosis. (Full) The gross
removal of plaque and calculus that interfere with the ability of the dentist to perform a
DCDT D4355 No
comprehensive oral evaluation. This preliminary procedure does not preclude the need for
additional procedures.
(Short) localized delivery of antimicrobial agents via a controlled release vehicle into diseased
crevicular tissue, per tooth, by report. (Full) FDA approved subgingival delivery devices containing
DCDT D4381 antimicrobial medication(s) are inserted into periodontal pockets to suppress the pathogenic No
microbiota. These devices slowly release the pharmacological agents so they can remain at the
intended site of action in a therapeutic concentration for a sufficient length of time.
(Short) periodontal maintenance . (Full) This procedure is instituted following periodontal therapy
and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life
of the dentition or any implant replacements. It includes removal of the bacterial plaque and
DCDT D4910 No
calculus from supragingival and subgingival regions, site specific scaling and root planing where
indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional
diagnostic and treatment procedures must be considered.

DCDT D4920 (Short) unscheduled dressing change (by someone other than treating dentist). (Full) No

(Short) unspecified periodontal procedure, by report. (Full) Use for procedure that is not
DCDT D4999 No
adequately described by a code. Describe procedure.

DCDT D5110 (Short) complete denture - maxillary. (Full) Yes

DCDT D5120 (Short) complete denture - mandibular . (Full) Yes

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 (Short) immediate denture - maxillary. (Full) Includes limited follow-up care only; does not include
DCDT D5130 Yes
required future rebasing/relining procedure(s) or a complete new denture.

(Short) immediate denture - mandibular. (Full) Includes limited follow-up care only; does not
DCDT D5140 Yes
include required future rebasing/relining procedure(s) or a complete new denture.

(Short) maxillary partial denture - resin base (including any conventional clasps, rests and teeth).
DCDT D5211 Yes
(Full) Includes acrylic resin base denture with resin or wrought wire clasps.

(Short) mandibular partial denture - resin base (including any conventional clasps, rests and teeth).
DCDT D5212 Yes
(Full) Includes acrylic resin base denture with resin or wrought wire clasps.

(Short) maxillary partial denture - cast metal framework with resin denture bases (including any
DCDT D5213 Yes
conventional clasps, rests and teeth). (Full)

(Short) mandibular partial denture - cast metal framework with resin denture bases (including any
DCDT D5214 Yes
conventional clasps, rests and teeth). (Full)

DCDT D5225 (Short) maxillary partial denture - flexible base (including any clasps, rests and teeth). (Full) Yes

DCDT D5226 (Short) mandibular partial denture - flexible base (including any clasps, rests and teeth). (Full) Yes

(Short) removable unilateral partial denture - one piece cast metal (including clasps and teeth.
DCDT D5281 Yes
(Full)

DCDT D5410 (Short) adjust complete denture - maxillary. (Full) No

DCDT D5411 (Short) adjust complete denture - mandibular. (Full) No

DCDT D5421 (Short) adjust partial denture - maxillary. (Full) No

DCDT D5422 (Short) adjust partial denture - mandibular. (Full) No

DCDT D5510 (Short) repair broken complete denture base. (Full) No

DCDT D5520 (Short) replace missing or broken teeth - complete denture (each tooth). (Full) No

DCDT D5610 (Short) repair resin denture base. (Full) No

DCDT D5620 (Short) repair cast framework. (Full) No

DCDT D5630 (Short) repair or replace broken clasp. (Full) No

DCDT D5640 (Short) replace broken teeth - per tooth. (Full) No

DCDT D5650 (Short) add tooth to existing partial denture. (Full) No

DCDT D5660 (Short) add clasp to existing partial denture. (Full) No

DCDT D5670 (Short) replace all teeth and acrylic on cast metal framework (maxillary) . (Full) No

DCDT D5671 (Short) replace all teeth and acrylic on cast metal framework (mandibular). (Full) No

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 DCDT D5710 (Short) rebase complete maxillary denture. (Full) No

DCDT D5711 (Short) rebase complete mandibular denture. (Full) No

DCDT D5720 (Short) rebase maxillary partial denture. (Full) No

DCDT D5721 (Short) rebase mandibular partial denture. (Full) No

DCDT D5730 (Short) reline complete maxillary denture (chairside). (Full) No

DCDT D5731 (Short) reline complete mandibular denture (chairside). (Full) No

DCDT D5740 (Short) reline maxillary partial denture (chairside). (Full) No

DCDT D5741 (Short) reline mandibular partial denture (chairside). (Full) No

DCDT D5750 (Short) reline complete maxillary denture (laboratory). (Full) No

DCDT D5751 (Short) reline complete mandibular denture (laboratory). (Full) No

DCDT D5760 (Short) reline maxillary partial denture (laboratory) . (Full) No

DCDT D5761 (Short) reline mandibular partial denture (laboratory). (Full) No

DCDT D5810 (Short) interim complete denture (maxillary). (Full) Yes

DCDT D5811 (Short) interim complete denture (mandibular). (Full) Yes

DCDT D5820 (Short) interim partial denture (maxillary). (Full) Includes any necessary clasps and rests. Yes

DCDT D5821 (Short) interim partial denture (mandibular). (Full) Includes any necessary clasps and rests. Yes

(Short) tissue conditioning, maxillary. (Full) Treatment reline using materials designed to heal
DCDT D5850 No
unhealthy ridges prior to more definitive final restoration.

(Short) tissue conditioning, mandibular. (Full) Treatment reline using materials designed to heal
DCDT D5851 No
unhealthy ridges prior to more definitive final restoration.

(Short) overdenture - complete, by report. (Full) Describe and document procedures as performed.
DCDT D5860 Yes
Other separate procedures may be required concurrent to D5860.

(Short) overdenture - partial, by report. (Full) Describe and document procedures as performed.
DCDT D5861 Yes
Other separate procedures may be required concurrent to D5861.

(Short) precision attachment, by report. (Full) Each set of male and female components should be
DCDT D5862 Yes
reported as one precision attachment. Describe the type of attachment used.

(Short) replacement of replaceable part of semi-precision or precision attachment (male or female

DCDT D5867 Yes
component). (Full)

(Short) modification of removable prosthesis following implant surgery. (Full) The modification of
existing removable prosthesis is sometimes necessary at the time of implant placement and bone
graft surgery and is always necessary at the time of the placement of the healing caps. This code
DCDT D5875 Yes
could also be used to report the modification of an existing prosthesis when the abutments are
placed and retentive elements are placed into the removable prosthesis, thereby reducing the need
for a new prosthesis.

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 (Short) unspecified removable prosthodontic procedure, by report. (Full) Use for a procedure that
DCDT D5899 Yes
is not adequately described by a code. Describe procedure.

(Short) facial moulage (sectional). (Full) A sectional facial moulage impression is a procedure used
to record the soft tissue contours of a portion of the face. Occasionally several separate sectional
DCDT D5911 Yes
impressions are made, then reassembled to provide a full facial contour cast. The impression is
utilized to create a partial facial moulage and generally is not reusable.
(Short) facial moulage (complete). (Full) Synonymous terminology: facial impression, face mask
impression. A complete facial moulage impression is a procedure used to record the soft tissue
DCDT D5912 Yes
contours of the whole face. The impression is utilized to create a facial moulage and generally is
not reusable.
(Short) nasal prosthesis. (Full) Synonymous terminology: artificial nose. A removable prosthesis
attached to the skin, which artificially restores part or all of the nose. Fabrication of a nasal
prosthesis requires creation of an original mold. Additional prostheses usually can be made from
DCDT D5913 Yes
the same mold, and assuming no further tissue changes occur, the same mold can be utilized for
extended periods of time. When a new prosthesis is made from the existing mold, this procedure is
termed a nasal prosthesis replacement.
(Short) auricular prosthesis. (Full) Synonymous terminology: artificial ear, ear prosthesis. A
removable prosthesis, which artificially restores part or all of the natural ear. Usually, replacement
DCDT D5914 prostheses can be made from the original mold if tissue bed changes have not occurred. Creation Yes
of an auricular prosthesis requires fabrication of a mold, from which additional prostheses usually
can be made, as needed later (auricular prosthesis, replacement).
(Short) orbital prosthesis. (Full) A prosthesis, which artificially restores the eye, eyelids, and
adjacent hard and soft tissue, lost as a result of trauma or surgery. Fabrication of an orbital
prosthesis requires creation of an original mold. Additional prostheses usually can be made from
DCDT D5915 Yes
the same mold, and assuming no further tissue changes occur, the same mold can be utilized for
extended periods of time. When a new prosthesis is made from the existing mold, this procedure is
termed an orbital prosthesis replacement.
(Short) ocular prosthesis. (Full) Synonymous terminology: artificial eye, glass eye. A prosthesis,
which artificially replaces an eye missing as a result of trauma, surgery or congenital absence. The
prosthesis does not replace missing eyelids or adjacent skin, mucosa or muscle. Ocular prostheses
DCDT D5916 Yes
require semiannual or annual cleaning and polishing. Also, occasional revisions to re-adapt the
prosthesis to the tissue bed may be necessary. Glass eyes are rarely made and cannot be re-
adapted.
(Short) facial prosthesis. (Full) Synonymous terminology: prosthetic dressing. A removable
prosthesis, which artificially replaces a portion of the face, lost due to surgery, trauma or congenital
DCDT D5919 absence. Flexion of natural tissues may preclude adaptation and movement of the prosthesis to Yes
match the adjacent skin. Salivary leakage, when communicating with the oral cavity, adversely
affects retention.
(Short) nasal septal prosthesis. (Full) Synonymous terminology: Septal plug, septal button.
Removable prosthesis to occlude (obturate) a hole within the nasal septal wall. Adverse chemical
DCDT D5922 Yes
degradation in this moist environment may require frequent replacement. Silicone prostheses are
occasionally subject to fungal invasion.
(Short) ocular prosthesis, interim. (Full) Synonymous terminology: Eye shell, shell, ocular
conformer, conformer. A temporary replacement generally made of clear acrylic resin for an eye
DCDT D5923 Yes
lost due to surgery or trauma. No attempt is made to re-establish esthetics. Fabrication of an
interim ocular prosthesis generally implies subsequent fabrication of an aesthetic ocular prosthesis.

(Short) cranial prosthesis. (Full) Synonymous terminology: Skull plate, cranioplasty prosthesis,
DCDT D5924 cranial implant. A biocompatible, permanently implanted replacement of a portion of the skull Yes
bones; an artificial replacement for a portion of the skull bone.

(Short) facial augmentation implant prosthesis. (Full) Synonymous terminology: facial implant. An
implantable biocompatible material generally onlayed upon an existing bony area beneath the skin
tissue to fill in or collectively raise portions of the overlaying facial skin tissues to create acceptable
DCDT D5925 Yes
contours. Although some forms of pre-made surgical implants are commercially available, the facial
augmentation is usually custom made for surgical implantation for each individual patient due to
the irregular or extensive nature of the facial deficit.

(Short) nasal prosthesis, replacement. (Full) Synonymous terminology: replacement nose. An

artificial nose produced from a previously made mold. A replacement prosthesis does not require
DCDT D5926 Yes
fabrication of a new mold. Generally, several prostheses can be made from the same mold
assuming no changes occur in the tissue bed due to surgery or age related topographical variations.

(Short) auricular prosthesis, replacement. (Full) Synonymous terminology: replacement ear. An

artificial ear produced from a previously made mold. A replacement prosthesis does not require
DCDT D5927 Yes
fabrication of a new mold. Generally, several prostheses can be made from the same mold
assuming no changes occur in the tissue bed due to surgery or age related topographical variations.

(Short) orbital prosthesis, replacement. (Full) A replacement for a previously made orbital
prosthesis. A replacement prosthesis does not require fabrication of a new mold. Generally,
DCDT D5928 Yes
several prostheses can be made from the same mold assuming no changes occur in the tissue bed
due to surgery or age related topographical variations.
(Short) facial prosthesis, replacement. (Full) A replacement facial prosthesis made from the
original mold. A replacement prosthesis does not require fabrication of a new mold. Generally,
DCDT D5929 Yes
several prostheses can be made from the same mold assuming no changes occur in the tissue bed
due to further surgery or age related topographical variations.
(Short) obturator prosthesis, surgical. (Full) Synonymous terminology: Obturator, surgical
stayplate, immediate temporary obturator. A temporary prosthesis inserted during or immediately
DCDT D5931 following surgical or traumatic loss of a portion or all of one or both maxillary bones and contiguous Yes
alveolar structures (e.g., gingival tissue, teeth). Frequent revisions of surgical obturators are
necessary during the
(Short) obturator ensuing definitive.
prosthesis, healing phase (approximately
(Full) six months). obturator.
Synonymous terminology: Some dentists prefer to
A prosthesis,
which artificially replaces part or all of the maxilla and associated teeth, lost due to surgery, trauma
DCDT D5932 or congenital defects. A definitive obturator is made when it is deemed that further tissue changes Yes
or recurrence of tumor are unlikely and a more permanent prosthetic rehabilitation can be
achieved; it is intended for long-term use.
(Short) obturator prosthesis, modification. (Full) Synonymous terminology: adjustment, denture
adjustment, temporary or office reline. Revision or alteration of an existing obturator (surgical,
DCDT D5933 interim, or definitive); possible modifications include relief of the denture base due to tissue Yes
compression, augmentation of the seal or peripheral areas to affect adequate sealing or separation
between the nasal and oral cavities.
(Short) mandibular resection prosthesis with guide flange. (Full) Synonymous terminology:
resection device, resection appliance. A prosthesis which guides the remaining portion of the
DCDT D5934 mandible, left after a partial resection, into a more normal relationship with the maxilla. This Yes
allows for some tooth-to-tooth or an improved tooth contact. It may also artificially replace missing
teeth and thereby increase masticatory efficiency.

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 (Short) mandibular resection prosthesis without guide flange. (Full) A prosthesis which helps guide
the partially resected mandible to a more normal relation with the maxilla allowing for increased
tooth contact. It does not have a flange or ramp, however, to assist in directional closure. It may
replace missing teeth and thereby increase masticatory efficiency. Dentists who treat
mandibulectomy patients may prefer to replace some, all or none of the teeth in the defect area.
DCDT D5935 Yes
Frequently, the defect's margins preclude even partial replacement. Use of a guide (a mandibular
resection prosthesis with a guide flange) may not be possible due to anatomical limitations or poor
patient tolerance. Ramps, extended occlusal arrangements and irregular occlusal positioning
relative to the denture foundation frequently preclude stability of the prostheses, and thus some
prostheses are poorly tolerated under such adverse circumstances.

(Short) obturator prosthesis, interim. (Full) Synonymous terminology: immediate postoperative

obturator. A prosthesis which is made following completion of the initial healing after a surgical
resection of a portion or all of one or both the maxillae; frequently many or all teeth in the defect
area are replaced by this prosthesis. This prosthesis replaces the surgical obturator, which is usually
inserted at, or immediately following the resection.
Generally, an interim obturator is made to facilitate closure of the resultant defect after initial
DCDT D5936 healing has been completed. Unlike the surgical obturator, which usually is made prior to surgery Yes
and frequently revised in the operating room during surgery, the interim obturator is made when
the defect margins are clearly defined and further surgical revisions are not planned. It is a
provisional prosthesis, which may replace some or all lost teeth, and other lost bone and soft tissue
structures. Also, it frequently must be revised (termed an obturator prosthesis modification) during
subsequent dental procedures (e.g., restorations, gingival surgery) as well as to compensate for
further tissue shrinkage before a definitive obturator prosthesis is made.

(Short) trismus appliance (not for TMD treatment). (Full) Synonymous terminology: occlusal device
for mandibular trismus, dynamic bite opener. A prosthesis, which assists the patient in increasing
DCDT D5937 their oral aperture width in order to eat as well as maintain oral hygiene. Several versions and no
designs are possible, all intending to ease the severe lack of oral opening experienced by many
patients immediately following extensive intraoral surgical procedures.
(Short) feeding aid. (Full) Synonymous terminology: feeding prosthesis. A prosthesis, which
maintains the right and left maxillary segments of an infant cleft palate patient in their proper
DCDT D5951 orientation until surgery is performed to repair the cleft. It closes the oral-nasal cavity defect, thus Yes
enhancing sucking and swallowing. Used on an interim basis, this prosthesis achieves separation of
the oral speech
(Short) and nasal
aid cavities in infants
prosthesis, born (Full)
pediatric. with wide clefts necessitating
Synonymous terminology:delayed closure. It is
nasopharyngeal
obturator, speech appliance, obturator, cleft palate appliance, prosthetic speech aid, speech bulb.
DCDT D5952 A temporary or interim prosthesis used to close a defect in the hard and/or soft palate. It may Yes
replace tissue lost due to developmental or surgical alterations. It is necessary for the production of
intelligible speech.
(Short) speech Normal lateral
aid prosthesis, growth
adult. (Full)ofSynonymous
the palatal bones necessitates
terminology: occasional
prosthetic replacement
speech appliance,
speech aid, speech bulb. A definitive prosthesis, which can improve speech in adult cleft palate
DCDT D5953 patients either by obturating (sealing off) a palatal cleft or fistula, or occasionally by assisting an Yes
incompetent soft palate. Both mechanisms are necessary to achieve velopharyngeal competency.
Generally, this prosthesis is fabricated when no further growth is anticipated and the objective is to
(Short) palatal augmentation prosthesis. (Full) Synonymous terminology: superimposed
prosthesis, maxillary glossectomy prosthesis, maxillary speech prosthesis, palatal drop prosthesis.
DCDT D5954 Yes
A removable prosthesis which alters the hard and/or soft palate's topographical form adjacent to
the tongue.
(Short) palatal lift prosthesis, definitive. (Full) A prosthesis which elevates the soft palate
superiorly and aids in restoration of soft palate functions which may be lost due to an acquired,
DCDT D5955 congenital or developmental defect. A definitive palatal lift is usually made for patients whose Yes
experience with an interim palatal lift has been successful, especially if surgical alterations are
deemed unwarranted.
(Short) palatal lift prosthesis, interim. (Full) Synonymous terminology: diagnostic palatal lift. A
prosthesis which elevates and assists in restoring soft palate function which may be lost due to
clefting, surgery, trauma or unknown paralysis. It is intended for interim use to determine its
usefulness in achieving palatalpharyngeal competency or enhance swallowing reflexes. This
DCDT D5958 Yes
prosthesis is intended for interim use as a diagnostic aid to assess the level of possible
improvement in speech intelligibility. Some clinicians believe use of a palatal lift on an interim
basis may stimulate an otherwise flaccid soft palate to increase functional activity, subsequently
lessening its need.
(Short) palatal lift prosthesis, modification. (Full) Synonymous terminology: revision of lift,
DCDT D5959 adjustment. Alterations in the adaptation, contour, form or function of an existing palatal lift Yes
necessitated due to tissue impingement, lack of function, poor clasp adaptation or the like.

(Short) speech aid prosthesis, modification. (Full) Synonymous terminology: adjustment, repair,
revision. Any revision of a pediatric or adult speech aid not necessitating its replacement.
DCDT D5960 Frequently, revisions of the obturating section of any speech aid is required to facilitate enhanced Yes
speech intelligibility. Such revisions or repairs do not require complete remaking of the prosthesis,
thus extending its longevity.
(Short) surgical stent. (Full) Synonymous terminology: periodontal stent, skin graft stent,
columellar stent. Stents are utilized to apply pressure to soft tissues to facilitate healing and
DCDT D5982 prevent cicatrization or collapse. A surgical stent may be required in surgical and post-surgical Yes
revisions to achieve close approximation of tissues. Usually such materials as temporary or interim
soft denture liners, gutta percha, or dental modeling impression compound may be used.
(Short) radiation carrier. (Full) Synonymous terminology: radiotherapy prosthesis, carrier
prosthesis, radiation applicator, radium carrier, intracavity carrier, intracavity applicator. A device
used to administer radiation to confined areas by means of capsules, beads or needles of radiation
DCDT D5983 emitting materials such as radium or cesium. Its function is to hold the radiation source securely in No
the same location during the entire period of treatment. Radiation oncologists occasionally request
these devices to achieve close approximation and controlled application of radiation to a tumor
deemed amiable to eradication.
(Short) radiation shield. (Full) Synonymous terminology: radiation stent, tongue protector, lead
DCDT D5984 shield. An intraoral prosthesis designed to shield adjacent tissues from radiation during No
orthovoltage treatment of malignant lesions of the head and neck region.

(Short) radiation cone locator. (Full) Synonymous terminology: docking device, cone locator. A
DCDT D5985 prosthesis utilized to direct and reduplicate the path of radiation to an oral tumor during a split No
course of irradiation.

(Short) fluoride gel carrier. (Full) Synonymous terminology: fluoride applicator. A prosthesis,
DCDT D5986 which covers the teeth in either dental arch and is used to apply topical fluoride in close proximity No
to tooth enamel and dentin for several minutes daily.

(Short) commissure splint. (Full) Synonymous terminology: lip splint. A device placed between the
lips, which assists in achieving increased opening between the lips. Use of such devices enhances
DCDT D5987 No
opening where surgical, chemical or electrical alterations of the lips has resulted in severe
restriction or contractures.

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 (Short) surgical splint. (Full) Synonymous terminology: Gunning splint, modified Gunning splint,
labiolingual splint, fenestrated splint, Kingsley splint, cast metal splint. Splints are designed to
utilize existing teeth and/or alveolar processes as points of anchorage to assist in stabilization and
immobilization of broken bones during healing. They are used to re-establish, as much as possible,
DCDT D5988 normal occlusal relationships during the process of immobilization. Frequently, existing prostheses No
(e.g., a patient's complete dentures) can be modified to serve as surgical splints. Frequently,
surgical splints have arch bars added to facilitate intermaxillary fixation. Rubber elastics may be
used to assist in this process. Circummandibular eyelet hooks can be utilized for enhanced
stabilization with wiring to adjacent bone.
(Short) topical medicament carrier. (Full) A custom fabricated carrier that covers the teeth and
alveolar mucosa, or alveolar mucosa alone, and is used to deliver topical corticosteroids and similar
effective medicaments for maximum sustained contact with the alveolar ridge and/or attached
DCDT D5991 No
gingival tissues for the control and management of immunologically mediated vesiculobullous
mucosal, chronic recurrent ulcerative, and other desquamative diseases of the gingiva and oral
mucosa.

DCDT D5992 (Short) adjust maxillofacial prosthetic appliance, by report. (Full) Yes

(Short) maintenance and cleaning of a maxillofacial prosthesis (extra or intraoral) other than
DCDT D5993 No
required adjustments, by report. (Full) Maintenance and cleaning of a maxillofacial prosthesis.

(Short) unspecified maxillofacial prosthesis, by report. (Full) Used for procedure that is not
DCDT D5999 Yes
adequately described by a code. Describe procedure.

(Short) radiographic/surgical implant index, by report. (Full) An appliance, designed to relate

DCDT D6190 osteotomy or fixture position to existing anatomic structures, to be utilized during radiographic Yes
exposure for treatment planning and/or during osteotomy creation for fixture installation.

(Short) surgical placement of implant body: endosteal implant. (Full) Includes second stage
DCDT D6010 Yes
surgery and placement of healing cap.

(Short) surgical placement of interim implant body for transitional prosthesis: endosteal implant.
DCDT D6012 (Full) Includes removal during later therapy to accommodate the definitive restoration, which may Yes
include placement of other implants.

(Short) surgical placement: eposteal implant. (Full) An eposteal (subperiosteal) framework of a

biocompatible material designed and fabricated to fit on the surface of the bone of the mandible or
DCDT D6040 maxilla with permucosal extensions which provide support and attachment of a prosthesis. This Yes
may be a complete arch or unilateral appliance. Eposteal implants rest upon the bone and under
the periosteum.
(Short) surgical placement: transosteal implant. (Full) A transosteal (transosseous) biocompatible
device with threaded posts penetrating both the superior and inferior cortical bone plates of the
DCDT D6050 mandibular symphysis and exiting through the permucosa providing support and attachment for a Yes
dental prosthesis. Transosteal implants are placed completely through the bone and into the oral
cavity from extraoral or intraoral.

(Short) implant removal, by report. (Full) This procedure involves the surgical removal of an
DCDT D6100 Yes
implant. Describe procedure.

(Short) connecting bar – implant supported or abutment supported. (Full) Utilized to stabilize and
DCDT D6055 Yes
anchor a prosthesis.

(Short) prefabricated abutment - includes placement. (Full) A connection to an implant that is a

manufactured component usually made of machined high noble metal, titanium, titanium alloy or
DCDT D6056 Yes
ceramic. Modification of a prefabricated abutment may be necessary, and is accomplished by
altering its shape using dental burrs/diamonds.
(Short) custom abutment - includes placement. (Full) A connection to an implant that is a
fabricated component, usually by a laboratory, specific for an individual application. A custom
DCDT D6057 Yes
abutment is typically fabricated using a casting process and usually is made of noble or high noble
metal. A 'UCLA abutment' is an example of this type abutment.

DCDT D6053 (Short) implant/abutment supported removable denture for completely edentulous arch. (Full) Yes

DCDT D6054 (Short) implant/abutment supported removable denture for partially edentulous arch. (Full) Yes

(Short) implant/abutment supported fixed denture for completely edentulous arch. (Full) A
prosthesis that is retained, supported and stabilized by implants or abutments placed on implants
DCDT D6078 Yes
but does not have specific relationships between implant positions and replacement teeth; may be
screw retained or cemented; commonly referred to as a "hybrid prosthesis."
(Short) implant/abutment supported fixed denture for partially edentulous arch. (Full) A prosthesis
that is retained, supported and stabilized by implants or abutments placed on implants but does not
DCDT D6079 Yes
have specific relationship between implant positions and replacement teeth; may be screw retained
or cemented; commonly referred to as a "hybrid prosthesis"

(Short) abutment supported porcelain/ceramic crown. (Full) A single crown restoration that is
DCDT D6058 retained, supported and stabilized by an abutment on an implant; may be screw retained or Yes
cemented.

(Short) abutment supported porcelain fused to metal crown (high noble metal) . (Full) A single
DCDT D6059 metal-ceramic crown restoration that is retained, supported and stabilized by an abutment on an Yes
implant; may be screw retained or cemented.

(Short) abutment supported porcelain fused to metal crown (predominantly base metal). (Full) A
DCDT D6060 single metal-ceramic crown restoration that is retained, supported and stabilized by an abutment Yes
on an implant; may be screw retained or cemented.

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 (Short) abutment supported porcelain fused to metal crown (noble metal) . (Full) A single metal-
DCDT D6061 ceramic crown restoration that is retained, supported and stabilized by an abutment on an implant; Yes
may be screw retained or cemented.

(Short) abutment supported cast metal crown (high noble metal). (Full) A single cast metal crown
DCDT D6062 restoration that is retained, supported and stabilized by an abutment on an implant; may be screw Yes
retained or cemented.

(Short) abutment supported cast metal crown (predominantly base metal). (Full) A single cast
DCDT D6063 metal crown restoration that is retained, supported and stabilized by an abutment on an implant; Yes
may be screw retained or cemented.

(Short) abutment supported cast metal crown (noble metal). (Full) A single cast metal crown
DCDT D6064 restoration that is retained, supported and stabilized by an abutment on an implant; may be screw Yes
retained or cemented.

(Short) abutment supported crown - (titanium). (Full) A single restoration that is retained,
DCDT D6094 supported and stabilized by an abutment on an implant. May be cast or milled and is screw Yes
retained or cemented.

(Short) implant supported porcelain/ceramic crown. (Full) A single crown restoration that is
DCDT D6065 Yes
retained, supported and stabilized by an implant; may be screw retained or cemented.

(Short) implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble
DCDT D6066 metal). (Full) A single metal-ceramic crown restoration that is retained, supported and stabilized Yes
by an implant; may be screw retained or cemented.

(Short) implant supported metal crown (titanium, titanium alloy, high noble metal). (Full) A single
DCDT D6067 cast metal or milled crown restoration that is retained, supported and stabilized by an implant; may Yes
be screw retained or cemented.

(Short) abutment supported retainer for porcelain/ceramic FPD. (Full) A ceramic retainer for a
DCDT D6068 fixed partial denture that gains retention, support and stability from an abutment on an implant; Yes
may be screw retained or cemented.

(Short) abutment supported retainer for porcelain fused to metal FPD (high noble metal). (Full) A
DCDT D6069 metal-ceramic retainer for a fixed partial denture that gains retention, support and stability from an Yes
abutment on an implant; may be screw retained or cemented.

(Short) abutment supported retainer for porcelain fused to metal FPD (predominantly base metal).
DCDT D6070 (Full) A metal-ceramic retainer for a fixed partial denture that gains retention, support and stability Yes
from an abutment on an implant; may be screw retained or cemented.

(Short) abutment supported retainer for porcelain fused to metal FPD (noble metal). (Full) A metal-
DCDT D6071 ceramic retainer for a fixed partial denture that gains retention, support and stability from an Yes
abutment on an implant; may be screw retained or cemented.

(Short) abutment supported retainer for cast metal FPD (high noble metal). (Full) A cast metal
DCDT D6072 retainer for a fixed partial denture that gains retention, support and stability from an abutment on Yes
an implant; may be screw retained or cemented.

(Short) abutment supported retainer for cast metal FPD (predominantly base metal). (Full) A cast
DCDT D6073 metal retainer for a fixed partial denture that gains retention, support and stability from an Yes
abutment on an implant; may be screw retained or cemented.

(Short) abutment supported retainer for cast metal FPD (noble metal). (Full) A cast metal retainer
DCDT D6074 for a fixed partial denture that gains retention, support and stability from an abutment on an Yes
implant; may be screw retained or cemented.

(Short) abutment supported retainer crown for FPD - (titanium). (Full) A retainer for a fixed partial
DCDT D6194 denture that gains retention, support and stability from an abutment on an implant. May be cast or Yes
milled and is screw retained or cemented.

(Short) implant supported retainer for ceramic FPD. (Full) A ceramic retainer for a fixed partial
DCDT D6075 denture that gains retention, support and stability from an implant; may be screw retained or Yes
cemented.

(Short) implant supported retainer for porcelain fused to metal FPD (titanium, titanium alloy, or
DCDT D6076 high noble metal). (Full) A metal-ceramic retainer for a fixed partial denture that gains retention, Yes
support and stability from an implant; may be screw retained or cemented.

(Short) implant supported retainer for cast metal FPD (titanium, titanium alloy, or high noble
DCDT D6077 metal). (Full) A cast metal retainer for a fixed partial denture that gains retention, support and Yes
stability from an implant; may be screw retained or cemented.
(Short) implant maintenance procedures, including removal of prosthesis, cleansing of prosthesis
and abutments and reinsertion of prosthesis. (Full) This procedure includes a prophylaxis to
DCDT D6080 provide active debriding of the implant and examination of all aspects of the implant system, Yes
including the occlusion and stability of the superstructure. The patient is also instructed in thorough
daily cleansing of the implant.

(Short) repair implant supported prosthesis, by report. (Full) This procedure involves the repair or
DCDT D6090 Yes
replacement of any part of the implant supported prosthesis.

(Short) repair implant abutment, by report. (Full) This procedure involves the repair or
DCDT D6095 Yes
replacement of any part of the implant abutment.

(Short) replacement of semi-precision or precision attachment (male or female component) of

DCDT D6091 implant/abutment supported prosthesis, per attachment. (Full) This procedure applies to the Yes
replaceable male or female component of the attachment

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 DCDT D6092 (Short) recement implant/abutment supported crown. (Full) No

DCDT D6093 (Short) recement implant/abutment supported fixed partial denture. (Full) No

(Short) unspecified implant procedure, by report. (Full) Use for procedure that is not adequately
DCDT D6199 Yes
described by a code. Describe procedure.

(Short) pontic - indirect resin based composite. (Full) Not to be used as a temporary or provisional
DCDT D6205 Yes
prosthesis.

DCDT D6210 (Short) pontic - cast high noble metal. (Full) Yes

DCDT D6211 (Short) pontic - cast predominantly base metal. (Full) Yes

DCDT D6212 (Short) pontic - cast noble metal. (Full) Yes

DCDT D6214 (Short) pontic - titanium. (Full) Yes

DCDT D6240 (Short) pontic - porcelain fused to high noble metal. (Full) Yes

DCDT D6241 (Short) pontic - porcelain fused to predominantly base metal. (Full) Yes

DCDT D6242 (Short) pontic - porcelain fused to noble metal. (Full) Yes

DCDT D6245 (Short) pontic - porcelain/ceramic . (Full) Yes

DCDT D6250 (Short) pontic - resin with high noble metal. (Full) Yes

DCDT D6251 (Short) pontic - resin with predominantly base metal. (Full) Yes

DCDT D6252 (Short) pontic - resin with noble metal. (Full) Yes

(Short) provisional pontic. (Full) Pontic utilized as an interim of at least six months duration during
DCDT D6253 restorative treatment to allow adequate time for healing or completion of other procedures. This is Yes
not to be used as a temporary pontic for routine prosthetic fixed partial dentures.

(Short) interim pontic. (Full) Pontic used as an interim restoration for a duration of less than six
months when a final impression is not made to allow adequate time for healing or completion of
DCDT D6254 Yes
definitive treatment planning. This is not a temporary pontic for routine prosthetic fixed partial
denture restoration.

DCDT D6545 (Short) retainer - cast metal for resin bonded fixed prosthesis. (Full) Yes

DCDT D6548 (Short) retainer - porcelain/ceramic for resin bonded fixed prosthesis. (Full) Yes

DCDT D6600 (Short) inlay - porcelain/ceramic, two surfaces . (Full) Yes

DCDT D6601 (Short) inlay - porcelain/ceramic, three or more surfaces. (Full) Yes

DCDT D6602 (Short) inlay - cast high noble metal, two surfaces. (Full) Yes

DCDT D6603 (Short) inlay - cast high noble metal, three or more surfaces. (Full) Yes

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 DCDT D6604 (Short) inlay - cast predominantly base metal, two surfaces. (Full) Yes

DCDT D6605 (Short) inlay - cast predominantly base metal, three or more surfaces. (Full) Yes

DCDT D6606 (Short) inlay - cast noble metal, two surfaces. (Full) Yes

DCDT D6607 (Short) inlay - cast noble metal, three or more surfaces. (Full) Yes

DCDT D6624 (Short) inlay - titanium. (Full) Yes

DCDT D6608 (Short) onlay -porcelain/ceramic, two surfaces. (Full) Yes

DCDT D6609 (Short) onlay - porcelain/ceramic, three or more surfaces. (Full) Yes

DCDT D6610 (Short) onlay - cast high noble metal, two surfaces. (Full) Yes

DCDT D6611 (Short) onlay - cast high noble metal, three or more surfaces. (Full) Yes

DCDT D6612 (Short) onlay - cast predominantly base metal, two surfaces. (Full) Yes

DCDT D6613 (Short) onlay - cast predominantly base metal, three or more surfaces. (Full) Yes

DCDT D6614 (Short) onlay - cast noble metal, two surfaces. (Full) Yes

DCDT D6615 (Short) onlay - cast noble metal, three or more surfaces. (Full) Yes

DCDT D6634 (Short) onlay - titanium. (Full) Yes

(Short) crown - indirect resin based composite . (Full) Not to be used as a temporary or
DCDT D6710 Yes
provisional prosthesis.

DCDT D6720 (Short) crown - resin with high noble metal. (Full) Yes

DCDT D6721 (Short) crown - resin with predominantly base metal. (Full) Yes

DCDT D6722 (Short) crown - resin with noble metal. (Full) Yes

DCDT D6740 (Short) crown - porcelain/ceramic. (Full) Yes

DCDT D6750 (Short) crown - porcelain fused to high noble metal. (Full) Yes

DCDT D6751 (Short) crown - porcelain fused to predominantly base metal. (Full) Yes

DCDT D6752 (Short) crown - porcelain fused to noble metal. (Full) Yes

DCDT D6780 (Short) crown - 3/4 cast high noble metal. (Full) Yes

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 DCDT D6781 (Short) crown - 3/4 cast predominantly base metal. (Full) Yes

DCDT D6782 (Short) crown - 3/4 cast noble metal. (Full) Yes

DCDT D6783 (Short) crown - 3/4 porcelain/ceramic. (Full) Yes

DCDT D6790 (Short) crown - full cast high noble metal. (Full) Yes

DCDT D6791 (Short) crown - full cast predominantly base metal. (Full) Yes

DCDT D6792 (Short) crown - full cast noble metal. (Full) Yes

DCDT D6794 (Short) crown - titanium. (Full) Yes

(Short) provisional retainer crown. (Full) Retainer crown utilized as an interim of at least six
months duration during restorative treatment to allow adequate time for healing or completion of
DCDT D6793 Yes
other procedures. This is not to be used as a temporary retainer crown for routine prosthetic fixed
partial dentures.
(Short) interim retainer crown. (Full) Retainer crown used as an interim restoration for a duration
of less than six months when a final impression is not made to allow adequate time for healing or
DCDT D6795 Yes
completion of definitive treatment planning. This is not a temporary retainer crown for routine
prosthetic fixed partial denture restoration.

(Short) connector bar. (Full) A device attached to fixed partial denture retainer or coping which
DCDT D6920 Yes
serves to stabilize and anchor a removable overdenture prosthesis.

DCDT D6930 (Short) recement fixed partial denture. (Full) No

DCDT D6940 (Short) stress breaker. (Full) A non-rigid connector. Yes

(Short) precision attachment. (Full) A male and female pair constitutes one precision attachment,
DCDT D6950 Yes
and is separate from the prosthesis.

(Short) post and core in addition to fixed partial denture retainer, indirectly fabricated. (Full) Post
DCDT D6970 No
and core are custom fabricated as a single unit.

DCDT D6972 (Short) prefabricated post and core in addition to fixed partial denture retainer. (Full) No

DCDT D6973 (Short) core build up for retainer, including any pins. (Full) No

(Short) coping - metal. (Full) To be used as a definitive restoration when coping is an integral part
DCDT D6975 Yes
of a fixed prosthesis.

DCDT D6976 (Short) each additional indirectly fabricated post - same tooth. (Full) To be used with D6970. Yes

DCDT D6977 (Short) each additional prefabricated post - same tooth. (Full) To be used with D6972 No

DCDT D6980 (Short) fixed partial denture repair, by report. (Full) No

(Short) pediatric partial denture, fixed . (Full) This prosthesis is used primarily for aesthetic
DCDT D6985 Yes
purposes.

(Short) unspecified fixed prosthodontic procedure, by report. (Full) Used for procedure that is not
DCDT D6999 Yes
adequately described by a code. Describe procedure.

(Short) extraction, coronal remnants - deciduous tooth. (Full) Removal of soft tissue-retained
DCDT D7111 No
coronal remnants.

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 (Short) extraction, erupted tooth or exposed root (elevation and/or forceps removal). (Full)
DCDT D7140 Includes routine removal of tooth structure, minor smoothing of socket bone, and closure, as No
necessary.

(Short) surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and
DCDT D7210 including elevation of mucoperiosteal flap if indicated. (Full) Includes related cutting of gingiva and No
bone, removal of tooth structure, minor smoothing of socket bone and closure.

(Short) removal of impacted tooth - soft tissue. (Full) Occlusal surface of tooth covered by soft
DCDT D7220 No
tissue; requires mucoperiosteal flap elevation.

(Short) removal of impacted tooth - partially bony. (Full) Part of crown covered by bone; requires
DCDT D7230 No
mucoperiosteal flap elevation and bone removal.

(Short) removal of impacted tooth - completely bony. (Full) Most or all of crown covered by bone;
DCDT D7240 No
requires mucoperiosteal flap elevation and bone removal.

(Short) removal of impacted tooth - completely bony, with unusual surgical complications. (Full)
DCDT D7241 Most or all of crown covered by bone; unusually difficult or complicated due to factors such as nerve No
dissection required, separate closure of maxillary sinus required or aberrant tooth position.

(Short) surgical removal of residual tooth roots (cutting procedure). (Full) Includes cutting of soft
DCDT D7250 No
tissue and bone, removal of tooth structure, and closure.

(Short) coronectomy – intentional partial tooth removal. (Full) Intentional partial tooth removal is
DCDT D7251 No
performed when a neurovascular complication is likely if the entire impacted tooth is removed.

(Short) oroantral fistula closure. (Full) Excision of fistulous tract between maxillary sinus and oral
DCDT D7260 No
cavity and closure by advancement flap.

(Short) primary closure of a sinus perforation. (Full) Subsequent to surgical removal of tooth,
DCDT D7261 exposure of sinus requiring repair, or immediate closure of oroantral or oralnasal communication in No
absence of fistulus tract.

(Short) tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth. (Full)
DCDT D7270 No
Includes splinting and/or stabilization.

(Short) tooth transplantation (includes reimplantation from one site to another and splinting and/or
DCDT D7272 No
stabilization). (Full)

(Short) surgical access of an unerupted tooth. (Full) An incision is made and the tissue is reflected
DCDT D7280 and bone removed as necessary to expose the crown of an impacted tooth not intended to be No
extracted.

(Short) mobilization of erupted or malpositioned tooth to aid eruption. (Full) To move/luxate teeth
DCDT D7282 No
to eliminate ankyolosis; not in conjunction with an extraction.

(Short) placement of device to facilitate eruption of impacted tooth. (Full) Placement of an

DCDT D7283 orthodontic bracket, band or other device on an unerupted tooth, after its exposure, to aid in its Yes
eruption. Report the surgical exposure separately using D7280.

(Short) biopsy of oral tissue - hard (bone, tooth). (Full) For removal of specimen only. This code
DCDT D7285 No
involves biopsy of osseous lesions and is not used for apicoectomy/periradicular surgery.

(Short) biopsy of oral tissue - soft . (Full) For surgical removal of an architecturally intact specimen
DCDT D7286 No
only. This code is not used at the same time as codes for apicoectomy/periradicular curettage.

(Short) exfoliative cytological sample collection. (Full) For collection of non-transepithelial cytology
DCDT D7287 No
sample via mild scraping of the oral mucosa.

(Short) brush biopsy - transepithelial sample collection. (Full) For collection of oral disaggregated
DCDT D7288 No
transepithelial cells via rotational brushing of the oral mucosa.

DCDT D7290 (Short) surgical repositioning of teeth. (Full) Grafting procedure(s) is/are additional Yes

(Short) transseptal fiberotomy/supra crestal fiberotomy, by report. (Full) The supraosseous

connective tissue attachment is surgically severed around the involved teeth. Where there are
DCDT D7291 adjacent teeth, the transseptal fiberotomy of a single tooth will involve a minimum of three teeth. No
Since the incisions are within the gingival sulcus and tissue and the root surface is not
instrumented, this procedure heals by the reunion of connective tissue with the root surface on
(Short) surgical placement: temporary anchorage device [screw retained plate] requiring surgical
DCDT D7292 flap. (Full) Insertion of a temporary skeletal anchorage device that is attached to the bone by Yes
screws and requires a surgical flap. Includes device removal.

(Short) surgical placement: temporary anchorage device requiring surgical flap. (Full) Insertion of
DCDT D7293 a device for temporary skeletal anchorage when a surgical flap is required. Includes device Yes
removal.

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 (Short) surgical placement: temporary anchorage device without surgical flap. (Full) Insertion of a
DCDT D7294 device for temporary skeletal anchorage when a surgical flap is not required. Includes device Yes
removal.

(Short) harvest of bone for use in autogenous grafting procedure. (Full) Reported in addition to
DCDT D7295 Yes
those autogenous graft placement procedures that do not include harvesting of bone.

(Short) alveoloplasty in conjunction with extractions – four or more teeth or tooth spaces, per
quadrant. (Full) The alveoloplasty is distinct (separate procedure) from extractions and/or surgical
DCDT D7310 No
extractions. Usually in preparation for a prosthesis or other treatments such as radiation therapy
and transplant surgery.
(Short) alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per
quadrant. (Full) The alveoloplasty is distinct (separate procedure) from extractions and/or surgical
DCDT D7311 No
extractions. Usually in preparation for a prosthesis or other treatments such as radiation therapy
and transplant surgery.
(Short) alveoloplasty not in conjunction with extractions –four or more teeth or tooth spaces, per
quadrant. (Full) No extractions performed in an edentulous area. See D7310 if teeth are being
DCDT D7320 No
extracted concurrently with the alveoloplasty. Usually in preparation for a prosthesis or other
treatments such as radiation therapy and transplant surgery.
(Short) alveoloplasty not in conjunction with extractions - one to three teeth or tooth spaces, per
quadrant. (Full) No extractions performed in an edentulous area. See D7311 if teeth are being
DCDT D7321 No
extracted concurrently with the alveoloplasty. Usually in preparation for a prosthesis or other
treatments such as radiation therapy and transplant surgery.

DCDT D7340 (Short) vestibuloplasty - ridge extension (secondary epithelialization). (Full) No

(Short) vestibuloplasty - ridge extension (including soft tissue grafts, muscle reattachment, revision
DCDT D7350 No
of soft tissue attachment and management of hypertrophied and hyperplastic tissue). (Full)

DCDT D7410 (Short) excision of benign lesion up to 1.25 cm. (Full) No

DCDT D7411 (Short) excision of benign lesion greater than 1.25 cm. (Full) No

(Short) excision of benign lesion, complicated . (Full) Requires extensive undermining with
DCDT D7412 No
advancement or rotational flap closure

DCDT D7413 (Short) excision of malignant lesion up to 1.25 cm. (Full) No

DCDT D7414 (Short) excision of malignant lesion greater than 1.25 cm. (Full) No

(Short) excision of malignant lesion, complicated . (Full) Requires extensive undermining with
DCDT D7415 No
advancement or rotational flap closure

(Short) destruction of lesion(s) by physical or chemical method, by report. (Full) Examples include
DCDT D7465 No
using cryo, laser or electro surgery.

DCDT D7440 (Short) excision of malignant tumor - lesion diameter up to 1.25 cm. (Full) No

DCDT D7441 (Short) excision of malignant tumor - lesion diameter greater than 1.25 cm. (Full) No

DCDT D7450 (Short) removal of benign odontogenic cyst or tumor - lesion diameter up to 1.25 cm. (Full) No

DCDT D7451 (Short) removal of benign odontogenic cyst or tumor - lesion diameter greater than 1.25 cm. (Full) No

DCDT D7460 (Short) removal of benign nonodontogenic cyst or tumor - lesion diameter up to 1.25 cm. (Full) No

(Short) removal of benign nonodontogenic cyst or tumor - lesion diameter greater than 1.25 cm.
DCDT D7461 No
(Full)

DCDT D7471 (Short) removal of lateral exostosis (maxilla or mandible). (Full) No

DCDT D7472 (Short) removal of torus palatinus. (Full) No

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 DCDT D7473 (Short) removal of torus mandibularis. (Full) No

DCDT D7485 (Short) surgical reduction of osseous tuberosity. (Full) No

(Short) radical resection of maxilla or mandible . (Full) Partial resection of maxilla or mandible;
DCDT D7490 removal of lesion and defect with margin of normal appearing bone. Reconstruction and bone No
grafts should be reported separately.

(Short) incision and drainage of abscess - intraoral soft tissue. (Full) Involves incision through
DCDT D7510 No
mucosa, including periodontal origins.

(Short) incision and drainage of abscess - intraoral soft tissue - complicated (includes drainage of
DCDT D7511 multiple fascial spaces). (Full) Incision is made intraorally and dissection is extended into adjacent No
fascial space(s) to provide adequate drainage of abscess/cellulitis.

(Short) incision and drainage of abscess - extraoral soft tissue. (Full) Involves incision through
DCDT D7520 No
skin.

(Short) incision and drainage of abscess - extraoral soft tissue - complicated (includes drainage of
DCDT D7521 multiple fascial spaces) . (Full) Incision is made extraorally and dissection is extended into No
adjacent fascial space(s) to provide adequate drainage of abscess/cellulitis.

DCDT D7530 (Short) removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue. (Full) No

(Short) removal of reaction producing foreign bodies, musculoskeletal system. (Full) May include,
DCDT D7540 No
but is not limited to, removal of splinters, pieces of wire, etc., from muscle and/or bone.

(Short) partial ostectomy/sequestrectomy for removal of non-vital bone. (Full) Removal of loose
DCDT D7550 No
or sloughed-off dead bone caused by infection or reduced blood supply.

DCDT D7560 (Short) maxillary sinusotomy for removal of tooth fragment or foreign body. (Full) No

(Short) maxilla - open reduction (teeth immobilized, if present). (Full) Teeth may be wired,
DCDT D7610 banded or splinted together to prevent movement. Surgical incision required for interosseous No
fixation.

(Short) maxilla - closed reduction (teeth immobilized, if present). (Full) No incision required to
DCDT D7620 No
reduce fracture. See D7610 if interosseous fixation is applied.

(Short) mandible - open reduction (teeth immobilized, if present). (Full) Teeth may be wired,
DCDT D7630 No
banded or splinted together to prevent movement. Surgical incision required to reduce fracture.

(Short) mandible - closed reduction (teeth immobilized, if present). (Full) No incision required to
DCDT D7640 No
reduce fracture. See D7630 if interosseous fixation is applied.

DCDT D7650 (Short) malar and/or zygomatic arch - open reduction . (Full) No

DCDT D7660 (Short) malar and/or zygomatic arch - closed reduction. (Full) No

(Short) alveolus closed reduction may include stabilization of teeth. (Full) Teeth may be wired,
DCDT D7670 No
banded or splinted together to prevent movement.

(Short) alveolus, open reduction may include stabilization of teeth. (Full) Teeth may be wired,
DCDT D7671 No
banded or splinted together to prevent movement.

(Short) facial bones - complicated reduction with fixation and multiple surgical approaches. (Full)
DCDT D7680 No
Facial bones include upper and lower jaw, cheek, and bones around eyes, nose, and ears.

DCDT D7710 (Short) maxilla open reduction. (Full) Surgical incision required to reduce fracture. No

DCDT D7720 (Short) maxilla - closed reduction. (Full) No

DCDT D7730 (Short) mandible - open reduction. (Full) Surgical incision required to reduce fracture. No

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 DCDT D7740 (Short) mandible - closed reduction. (Full) No

(Short) malar and/or zygomatic arch - open reduction. (Full) Surgical incision required to reduce
DCDT D7750 No
fracture.

DCDT D7760 (Short) malar and/or zygomatic arch - closed reduction. (Full) No

(Short) alveolus - open reduction stabilization of teeth. (Full) Fractured bone(s) are exposed to
DCDT D7770 No
mouth or outside the face. Surgical incision required to reduce fracture.

(Short) alveolus, closed reduction stabilization of teeth . (Full) Fractured bone(s) are exposed to
DCDT D7771 No
mouth or outside the face.

(Short) facial bones - complicated reduction with fixation and multiple surgical approaches . (Full)
DCDT D7780 Surgical incision required to reduce fracture. Facial bones include upper and lower jaw, cheek, and No
bones around eyes, nose, and ears.

DCDT D7810 (Short) open reduction of dislocation. (Full) Access to TMJ via surgical opening. No

DCDT D7820 (Short) closed reduction of dislocation. (Full) Joint manipulated into place; no surgical exposure. No

(Short) manipulation under anesthesia. (Full) Usually done under general anesthesia or
DCDT D7830 No
intravenous sedation.

(Short) condylectomy. (Full) Surgical removal of all or portion of the mandibular condyle (separate
DCDT D7840 No
procedure).

(Short) surgical discectomy, with/without implant. (Full) Excision of the intra-articular disc of a
DCDT D7850 No
joint.

(Short) disc repair. (Full) Repositioning and/or sculpting of disc; repair of perforated posterior
DCDT D7852 No
attachment.

DCDT D7854 (Short) synovectomy. (Full) Excision of a portion or all of the synovial membrane of a joint. No

DCDT D7856 (Short) myotomy. (Full) Cutting of muscle for therapeutic purposes (separate procedure). No

(Short) joint reconstruction. (Full) Reconstruction of osseous components including or excluding

DCDT D7858 No
soft tissues of the joint with autogenous, homologous, or alloplastic materials.

DCDT D7860 (Short) arthrotomy. (Full) Cutting into joint (separate procedure). No

(Short) arthroplasty. (Full) Reduction of osseous components of the joint to create a

DCDT D7865 No
pseudoarthrosis or eliminate an irregular remodeling pattern (osteophytes).

DCDT D7870 (Short) arthrocentesis. (Full) Withdrawal of fluid from a joint space by aspiration. No

(Short) non-arthroscopic lysis and lavage. (Full) Inflow and outflow catheters are placed into the
joint space. The joint is lavaged and manipulated as indicated in an effort to release minor
DCDT D7871 No
adhesions and synovial vacuum phenomenon as well as to remove inflammation products from the
joint space.

DCDT D7872 (Short) arthroscopy - diagnosis, with or without biopsy. (Full) No

(Short) arthroscopy - surgical: lavage and lysis of adhesions. (Full) Removal of adhesions using the
DCDT D7873 No
arthroscope and lavage of the joint cavities.

(Short) arthroscopy - surgical: disc repositioning and stabilization. (Full) Repositioning and
DCDT D7874 No
stabilization of disc using arthroscopic techniques.

(Short) arthroscopy - surgical: synovectomy. (Full) Removal of inflamed and hyperplastic synovium
DCDT D7875 No
(partial/complete) via an arthroscopic technique.

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 (Short) arthroscopy - surgical: discectomy. (Full) Removal of disc and remodeled posterior
DCDT D7876 No
attachment via the arthroscope.

(Short) arthroscopy - surgical: debridement. (Full) Removal of pathologic hard and/or soft tissue
DCDT D7877 No
using the arthroscope.

(Short) occlusal orthotic device, by report. (Full) Presently includes splints provided for treatment
DCDT D7880 No
of temporomandibular joint dysfunction.

(Short) unspecified TMD therapy, by report. (Full) Used for procedure that is not adequately
DCDT D7899 No
described by a code. Describe procedure.

DCDT D7910 (Short) suture of recent small wounds up to 5 cm. (Full) No

DCDT D7911 (Short) complicated suture - up to 5 cm. (Full) No

DCDT D7912 (Short) complicated suture - greater than 5 cm. (Full) No

DCDT D7920 (Short) skin graft (identify defect covered, location and type of graft). (Full) No

(Short) osteoplasty - for orthognathic deformities. (Full) Reconstruction of jaws for correction of
DCDT D7940 No
congenital, developmental or acquired traumatic or surgical deformity.

DCDT D7941 (Short) osteotomy - mandibular rami. (Full) No

DCDT D7943 (Short) osteotomy - mandibular rami with bone graft; includes obtaining the graft. (Full) No

(Short) osteotomy - segmented or subapical. (Full) Report by range of tooth numbers within
DCDT D7944 No
segment.

(Short) osteotomy - body of mandible. (Full) Surgical section of lower jaw. This includes the
DCDT D7945 surgical exposure, bone cut, fixation, routine wound closure and normal post-operative follow-up No
care.

(Short) LeFort I (maxilla - total). (Full) Surgical section of the upper jaw. This includes the
DCDT D7946 surgical exposure, bone cuts, downfracture, repositioning, fixation, routine wound closure and No
normal post-operative follow-up care.

(Short) LeFort I (maxilla - segmented). (Full) When reporting a surgically assisted palatal
DCDT D7947 expansion without downfracture, this code would entail a reduced service and should be "by No
report."

(Short) LeFort II or LeFort III (osteoplasty of facial bones for midface hypoplasia or retrusion)-
without bone graft. (Full) Surgical section of upper jaw. This includes the surgical exposure, bone
DCDT D7948 No
cuts, downfracture, segmentation of maxilla, repositioning, fixation, routine wound closure and
normal post-operative follow-up care.

DCDT D7949 (Short) LeFort II or LeFort III - with bone graft. (Full) Includes obtaining autografts. No

(Short) osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla - autogenous or

nonautogenous, by report. (Full) This code may be used for ridge augmentation or reconstruction
DCDT D7950 to increase height, width and/or volume or residual alveolar ridge. It includes obtaining autograft Yes
and/or allograft material. Placement of a barrier membrane, if used, should be reported
separately.
(Short) sinus augmentation with bone or bone substitutes. (Full) The augmentation of the sinus
cavity to increase alveolar height for reconstruction of edentulous portions of the maxilla. This
DCDT D7951 Yes
includes obtaining the bone or bone substitutes. Placement of a barrier membrane, if used, should
be reported separately.
(Short) bone replacement graft for ridge preservation – per site. (Full) Osseous autograft, allograft
or non-osseous graft is placed in an extraction or implant removal site at the time of the extraction
DCDT D7953 or removal to preserve ridge integrity (e.g., clinically indicated in preparation for implant Yes
reconstruction or where alveolar contour is critical to planned prosthetic reconstruction).
Membrane, if used
(Short) repair should be reported
of maxillofacial separately.
soft and/or hard tissue defect. (Full) Reconstruction of surgical,
traumatic, or congenital defects of the facial bones, including the mandible, may utilize autograft,
DCDT D7955 allograft, or alloplastic materials in conjunction with soft tissue procedures to repair and restore the No
facial bones to form and function. This does not include obtaining the graft and these procedures
may require multiple surgical approaches. This procedure does not include edentulous maxilla and
(Short) frenulectomy – also known as frenectomy or frenotomy – separate procedure not incidental
to another procedure. (Full) Surgical removal or release of mucosal and muscle elements of a
DCDT D7960 No
buccal, labial or lingual frenum that is associated with a pathological condition, or interferes with
proper oral development or treatment.

(Short) frenuloplasty. (Full) Excision of frenum with accompanying excision or repositioning of

DCDT D7963 No
aberrant muscle and z-plasty or other local flap closure.

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 DCDT D7970 (Short) excision of hyperplastic tissue - per arch. (Full) No

(Short) excision of pericoronal gingiva . (Full) Surgical removal of inflammatory or hypertrophied

DCDT D7971 No
tissues surrounding partially erupted/impacted teeth.

DCDT D7972 (Short) surgical reduction of fibrous tuberosity. (Full) No

(Short) sialolithotomy. (Full) Surgical procedure by which a stone within a salivary gland or its duct
DCDT D7980 No
is removed, either intraorally or extraorally.

DCDT D7981 (Short) excision of salivary gland, by report. (Full) No

(Short) sialodochoplasty. (Full) Surgical procedure for the repair of a defect and/or restoration of a
DCDT D7982 No
portion of a salivary gland duct.

(Short) closure of salivary fistula. (Full) Surgical closure of an opening between a salivary duct
DCDT D7983 and/or gland and the cutaneous surface, or an opening into the oral cavity through other than the No
normal anatomic pathway.

(Short) emergency tracheotomy. (Full) Surgical formation of a tracheal opening usually below the
DCDT D7990 No
cricoid cartilage to allow for respiratory exchange.

DCDT D7991 (Short) coronoidectomy. (Full) Surgical removal of the coronoid process of the mandible. No

DCDT D7995 (Short) synthetic graft - mandible or facial bones, by report. (Full) Includes allogenic material. No

DCDT D7996 (Short) implant-mandible for augmentation purposes (excluding alveolar ridge), by report. (Full) No

(Short) appliance removal (not by dentist who placed appliance), includes removal of archbar.
DCDT D7997 No
(Full)

(Short) intraoral placement of a fixation device not in conjunction with a fracture. (Full) The
DCDT D7998 placement of intermaxillary fixation appliance for documented medically accepted treatments not in No
association with fractures.

(Short) unspecified oral surgery procedure, by report . (Full) Used for procedure that is not
DCDT D7999 yes
adequately described by a code. Describe procedure.

DCDT D8010 (Short) limited orthodontic treatment of the primary dentition. (Full) Yes

DCDT D8020 (Short) limited orthodontic treatment of the transitional dentition. (Full) Yes

DCDT D8030 (Short) limited orthodontic treatment of the adolescent dentition. (Full) Yes

DCDT D8040 (Short) limited orthodontic treatment of the adult dentition. (Full) Yes

DCDT D8050 (Short) interceptive orthodontic treatment of the primary dentition. (Full) Yes

DCDT D8060 (Short) interceptive orthodontic treatment of the transitional dentition. (Full) Yes

DCDT D8070 (Short) comprehensive orthodontic treatment of the transitional dentition. (Full) Yes

DCDT D8080 (Short) comprehensive orthodontic treatment of the adolescent dentition. (Full) Yes

DCDT D8090 (Short) comprehensive orthodontic treatment of the adult dentition. (Full) Yes

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 (Short) removable appliance therapy. (Full) Removable indicates patient can remove; includes
DCDT D8210 Yes
appliances for thumb sucking and tongue thrusting.

(Short) fixed appliance therapy. (Full) Fixed indicates patient cannot remove appliance; includes
DCDT D8220 Yes
appliances for thumb sucking and tongue thrusting.

DCDT D8660 (Short) pre-orthodontic treatment visit . (Full) Yes

DCDT D8670 (Short) periodic orthodontic treatment visit (as part of contract). (Full) Yes

(Short) orthodontic retention (removal of appliances, construction and placement of retainer(s)).

DCDT D8680 Yes
(Full)

(Short) orthodontic treatment (alternative billing to a contract fee). (Full) Services provided by
DCDT D8690 dentist other than original treating dentist. A method of payment between the provider and Yes
responsible party for services that reflect an open-ended fee arrangement.

(Short) repair of orthodontic appliance. (Full) Does not include bracket and standard fixed ortho
DCDT D8691 No
appliances. It does include functional appliances and palatal expanders.

DCDT D8692 (Short) replacement of lost or broken retainer . (Full) yes

DCDT D8693 (Short) rebonding or recementing; and/or repair, as required, of fixed retainers. (Full) No

(Short) unspecified orthodontic procedure, by report . (Full) Used for procedure that is not
DCDT D8999 Yes
adequately described by a code. Describe procedure.

(Short) palliative (emergency) treatment of dental pain - minor procedure. (Full) This is typically
DCDT D9110 No
reported on a "per visit" basis for emergency treatment of dental pain.

(Short) fixed partial denture sectioning. (Full) Separation of one or more connections between
abutments and/or pontics when some portion of a fixed prosthesis is to remain intact and
DCDT D9120 No
serviceable following sectioning and extraction or other treatment. Includes all recontouring and
polishing of retained portions.

DCDT D9210 (Short) local anesthesia not in conjunction with operative or surgical procedures. (Full) No

DCDT D9211 (Short) regional block anesthesia. (Full) No

DCDT D9212 (Short) trigeminal division block anesthesia. (Full) No

DCDT D9215 (Short) local anesthesia in conjunction with operative or surgical procedures. (Full) No

(Short) deep sedation/general anesthesia - first 30 minutes. (Full) Anesthesia time begins when
the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive
monitoring protocol and remains in continuous attendance of the patient. Anesthesia services are
considered completed when the patient may be safely left under the observation of trained
DCDT D9220 No
personnel and the doctor may safely leave the room to attend to other patients or duties.
The level of anesthesia is determined by the anesthesia provider’s documentation of the
anesthetic’s effects upon the central nervous system and not dependent upon the route of
administration.
(Short) deep sedation/general anesthesia - each additional 15 minutes . (Full) Anesthesia time
begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and
DCDT D9221 non-invasive monitoring protocol and remains in continuous attendance of the patient. Anesthesia No
services are considered completed when the patient may be safely left under the observation of
trained personnel and the doctor may safely leave the room to attend to other patients or duties.

DCDT D9230 (Short) inhalation of nitrous oxide / anxiolysis, analgesia. (Full) No

(Short) intravenous conscious sedation/analgesia - first 30 minutes. (Full) Anesthesia time begins
when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-
DCDT D9241 invasive monitoring protocol and remains in continuous attendance of the patient. Anesthesia No
services are considered completed when the patient may be safely left under the observation of
trained personnel and the doctor may safely leave the room to attend to other patients or duties.
(Short) intravenous conscious sedation/analgesia - each additional 15 minutes. (Full) Anesthesia
time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia
and non-invasive monitoring protocol and remains in continuous attendance of the patient.
Anesthesia services are considered completed when the patient may be safely left under the
DCDT D9242 observation of trained personnel and the doctor may safely leave the room to attend to other No
patients or duties.
The level of anesthesia is determined by the anesthesia provider’s documentation of the
anesthetic’s effects upon the central nervous system and not dependent upon the route of
administration.

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 (Short) non-intravenous conscious sedation. (Full) A medically controlled state of depressed
consciousness while maintaining the patient's airway, protective reflexes and the ability to respond
to stimulation or verbal commands. It includes non-intravenous administration of sedative and/or
DCDT D9248 analgesic agent(s) and appropriate monitoring. No
The level of anesthesia is determined by the anesthesia provider’s documentation of the
anesthetic’s effects upon the central nervous system and not dependent upon the route of
administration.
(Short) consultation - diagnostic service provided by dentist or physician other than requesting
dentist or physician. (Full) A patient encounter with a practitioner whose opinion or advice
DCDT D9310 regarding evaluation and/or management of a specific problem; may be requested by another No
practitioner or appropriate source. The consultation includes an oral evaluation. The consulted
practitioner may initiate diagnostic and/or therapeutic services.

(Short) house/extended care facility call. (Full) Includes visits to nursing homes, long-term care
DCDT D9410 facilities, hospice sites, institutions, etc. Report in addition to reporting appropriate code numbers No
for actual services performed.

(Short) hospital or ambulatory surgical center call. (Full) Care provided outside the dentist’s office
DCDT D9420 to a patient who is in a hospital or ambulatory surgical center. Services delivered to the patient on No
the date of service are documented separately using the applicable procedure codes.

(Short) office visit for observation (during regularly scheduled hours) - no other services performed.
DCDT D9430 No
(Full)

DCDT D9440 (Short) office visit - after regularly scheduled hours. (Full) No

(Short) case presentation, detailed and extensive treatment planning. (Full) Established patient.
DCDT D9450 No
Not performed on same day as evaluation.

(Short) therapeutic parenteral drug, single administration. (Full) Includes single administration of
DCDT D9610 antibiotics, steroids, anti-inflammatory drugs, or other therapeutic medications. This code should No
not be used to report administration of sedative, anesthetic or reversal agents.
(Short) therapeutic parenteral drugs, two or more administrations, different medications. (Full)
Includes multiple administrations of antibiotics, steroids, anti-inflammatory drugs or other
DCDT D9612 therapeutic medications. This code should not be used to report administration of sedatives, No
anesthetic or reversal agents. This code should be reported when two or more different
medications are necessary and should not be reported in addition to code D9610 on the same date.
(Short) other drugs and/or medicaments, by report. (Full) Includes, but is not limited to oral
DCDT D9630 antibiotics, oral analgesics, and topical fluoride dispensed in the office for home use; does not No
include writing prescriptions.

(Short) application of desensitizing medicament. (Full) Includes in-office treatment for root
DCDT D9910 sensitivity. Typically reported on a "per visit" basis for application of topical fluoride. This code is No
not to be used for bases, liners or adhesives used under restorations.

(Short) application of desensitizing resin for cervical and/or root surface, per tooth. (Full) Typically
DCDT D9911 reported on a "per tooth" basis for application of adhesive resins. This code is not to be used for No
bases, liners, or adhesives used under restorations.

(Short) behavior management, by report. (Full) May be reported in addition to treatment

DCDT D9920 No
provided. Should be reported in 15-minute increments.

(Short) treatment of complications (post-surgical) - unusual circumstances, by report. (Full) For

DCDT D9930 No
example, treatment of a dry socket following extraction or removal of bony sequestrum.

(Short) occlusal guard, by report. (Full) Removable dental appliances, which are designed to
DCDT D9940 No
minimize the effects of bruxism (grinding) and other occlusal factors.

DCDT D9941 (Short) fabrication of athletic mouthguard. (Full) No

DCDT D9942 (Short) repair and/or reline of occlusal guard. (Full) No

(Short) occlusion analysis - mounted case. (Full) Includes, but is not limited to, facebow,
DCDT D9950 No
interocclusal records tracings, and diagnostic wax-up; for diagnostic casts, see D0470.

(Short) occlusal adjustment - limited. (Full) May also be known as equilibration; reshaping the
occlusal surfaces of teeth to create harmonious contact relationships between the maxillary and
DCDT D9951 mandibular teeth. Presently includes discing/odontoplasty/enamoplasty. Typically reported on a No
“per visit” basis. This should not be reported when the procedure only involves bite adjustment in
the routine post-delivery care for a direct/indirect restoration or fixed/removable prosthodontics.
(Short) occlusal adjustment - complete. (Full) Occlusal adjustment may require several
appointments of varying length, and sedation may be necessary to attain adequate relaxation of
the musculature. Study casts mounted on an articulating instrument may be utilized for analysis of
DCDT D9952 occlusal disharmony. It is designed to achieve functional relationships and masticatory efficiency in No
conjunction with restorative treatment, orthodontics, orthognathic surgery, or jaw trauma when
indicated. Occlusal adjustment enhances the healing potential of tissues affected by the lesions of
occlusal trauma.
(Short) enamel microabrasion . (Full) The removal of discolored surface enamel defects resulting
DCDT D9970 from altered mineralization or decalcification of the superficial enamel layer. Submit per treatment No
visit.

DCDT D9971 (Short) odontoplasty 1 - 2 teeth; includes removal of enamel projections. (Full) No

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 DCDT D9972 (Short) external bleaching - per arch. (Full) No

DCDT D9973 (Short) external bleaching - per tooth. (Full) No

DCDT D9974 (Short) internal bleaching - per tooth. (Full) No

(Short) unspecified adjunctive procedure, by report. (Full) Used for procedure that is not
DCDT D9999 No
adequately described by a code. Describe procedure.

DAMAN CONFIDENTIAL

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