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2008 HCPCS Alpha-Numeric Index 1 HCPCS 2008 Index

Prefabricated crown, D2930-D2933 . Preparation kits, dialysis, A4914 . Preparatory prosthesis, L5510-L5595 . chemotherapy, J8999 nonchemotherapy, J8499


Crowns â Prefabricated stainless steel crowns (D2930 and D2931) and prefabricated stainless steel crowns with resin window (D2933) for primary and permanent teeth are covered for participants of all ages; replacement within six months is not covered. â Prefabricated resin crowns are covered for ...

Medicaid Covered Services

Medicaid Covered Services 1 October 2003 Montana Department of Publ ic Health and Human Services Medicaid Covered Services •This table contains general information about services by provider type.


... 954-9 01-528-9373 Sealing washer 2 2 D2-549 01-165-2308 O-ring 2 2 D-305 A 01-528-9372 Drain jam nut 2 2 D2-550 01-165-2309 O-ring 2 2 41975-10 01-163-8812 Curtain, enter&exit 2 4 42975-11 01-163-8811 Curtain, center 1 2 63 SK-1433 01-523-8802 Pressure gauge, final rinse 1 1 64 D2930 01-428-6905 Solenoid valve, final rinse 1 1 65 D2930-RK ...


D2930 Prefabricated stainless steel crown; primary tooth (TOOTH) The provider must have available adequate radiographic evidence as justification for the use of stainless steel crowns, or other documentation if radiographs do not demonstrate the need for stainless steel crowns in a particular case.

NCHC Routine Dental Care Policy-revised-06-15-2011

Resin-based composite and prefabricated stainless steel crowns: D2390, D2930, D2931, D2932, D2933, D2934 Therapeutic pulpotomy: D3220, D3221

Dental Service Code Groupings with CDT-4 Codes

... Services for Resin Partial Denture D5211, D5212 SCG 18 - Dental Services under General Anesthesia D0120, D0150, D0210, D0220, D0230, D0272, D0274, D0330, D1120, D1201, D1203, D1351, D1510, D1515, D1520, D1525, D2140, D2150, D2160, D2161, D2330, D2331, D2332, D2335, D2390, D2391, D2392, D2393, D2394, D2930, ...

Index to Administrative Codes DDS/DH Schedule

Index to Administrative Codes DDS/DH Schedule PROCEDURE/TERM PAGE CODE porcelain fused to metal (PFM) bridge pontics D6240-D6242 19 bridge retainer - crowns D6750-D6752 21 crowns D2750-D2752 6 post and core D2952-D2954 7 precision attachment D5345,D5862,D6950 15 prefabricated crown D2930-D2933 7 Preventive D1000-D1999 2 ...

ADA Code Description

... crown - 3/4 cast high noble metal $440.13 d2782 crown - 3/4 cast noble metal $440.13 d2790 crown - full cast high noble metal $411.30 d2791 crown - full cast predominantly base met $346.50 d2792 crown - full cast noble metal $374.27 d2910 recement inlay onlay/part coverage resto $27.77 d2920 recement crown $27.77 d2930 ...


... Crown, Full Cast High Noble Metal $375.00* D0272 Bite Wing X-ray (2) $12.00 D2791 Crown, Full Cast Base Metal $345.00 D0274 Bite Wing X-ray (4) $18.00 D2721 Crown, Acrylic with Metal $285.00 D0330 Panoramic X-ray $36.00 D2710 Crown, Acrylic $220.00 D1110 Adult Prophylaxis-Teeth Cleaning (1 per year) $16.00 D2930 ...