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D0220

Dental Service Code Groupings with CDT-4 Codes

SCG 01 - Preventive Dental Services D0120, D0150, D0210, D0220, D0230, D0272, D0274, D0330, D1110, D1120, D1201, D1203, D1351 SCG 02 - Orthodontic Services for Medically Handicapping Malocclusion D0140, D0210, D0330, D0340, D0350, D0470, D8080, D8670, D8680 SCG 03 - Primary Dentition for Cleft Palate and/or ...

ADA Code

... Dental Fee Schedule Diagnostic Services D0110 and D0180 Initial Oral Examination $ 41.00 D0120 Periodic Oral Examination—two per year $ 21.00 D0140 Emergency or Problem Focused Oral Examination $ 41.00 D0150 Comprehensive Oral Examination $ 41.00 D0210 Intraoral-Complete Including Bitewings $ 68.00 D0220 ...

Code Description

... dental screening 35.00 $ d0140 limit oral eval problm focus 50.00 $ d0150 comprehensve oral evaluation 77.50 $ d0160 extensv oral eval prob focus 67.50 $ d0170 re-eval,est pt,problem focus 45.00 $ d0180 comp periodontal evaluation 77.50 $ d0210 intraor complete film series 91.00 $ d0220 ...

Dr. Rosenthal's Toolkit: Management Information System (MIS)

... greater than age 10 3 D0160 Detail and Extensive Oral Evaluation-age 10 and under 1.5 D0160 Detail and Extensive Oral Evaluation-over age 10 3 D0180 Comprehensive Periodontal Evaluation-age 10 and under 1.5 D0180 Comprehensive Periodontal Evaluation-over age 10 3 D0210 Intraoral - Complete Series 1.5 D0220 ...

CDT-4 Codes to Local Procedure Codes

... 996 Post-operative visits, symptomatic care and counseling D0180 Comprehensive periodontal evaluation - new or established patient 010 Complete exam - initial Global per Q -As of 04/29/03 D0210 Intraoral - complete series (including bitewings) 112 Intraoral, complete series D0220 Intraoral - periapical ...

Exceptions to the Adult Dental Changes

All pregnant and postpartum beneficiaries (children and adults) in limited scope aid codes and adult pregnant/postpartum beneficiaries in full scope aid codes are allowed the following radiographic procedures: D0220 Intraoral - periapical first film D0230 Intraoral - periapical each additional film ...

UTILIZATION REVIEW GUIDELINES

EXCEPTIONS: D0150 will NOT be converted to D0120 when the following procedure codes are found in history within the prior 36 months: D0140, D0220, &D7111-D9999 (including D9110).

Section 6 - Forms

: A rendering provider (NPI) number is required in Field 33 on all TAR/Claim forms and NOAs for any procedure codes other than the following: D0210, D0220, D0230, D0240, D0250, D0260, D0270, D0272, D0274, D0290, D0322, D0330, D0340, D0350, D1110, D1120, D1201, D1203, D1204, D1205, and D1351.

EPSDT DENTAL PROGRAM RESTORATION POLICY MULTIPLE RESTORATIONS ...

2 Procedure Codes Available for Reimbursement at the Full Fee for Multiple Restorations on the Same Permanent Tooth Within 12 Months Due to Pulpal Necrosis or Traumatic Injury

Dental Fee Schedule Comparison Date

untitled untitled. Dental Fee Schedule Comparison Date PPO Fee Schedule UCR at 90th Percentile D0120 Periodic Oral Evaluation $28.00 $85.00 D0150 Comprehensive Oral Evaluation $42.00 $100.00 D0210 Intraoral Complete Series $73.00 $150.00 D0220 Intraoral Periapical-1st Film $14.00 $25.00 D0230 ...