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little teeth
Our In House Dental Insurance Plan Info
TREATMENT INVOICE
This form is to be filled out everytime a treatment is rendered with the price.
INVOICE NUMBER
Members Username
admin
Apple Test
Courtney Williams
mogiyer
sam123
sathish17110
sathya
Shivani Desai
Stacy
Tyler707
Parent Members Email
Please make sure its the email they registered with.
TX CODE 1
D0001 Ortho Breakage
D0025 Antibiotics
D0030 MTA
D0035 Sedation Deposit
D0050 Little Teeth Insurance Exam
D0051 Little Teeth Insurance Prophy
D0052 Little Teeth Insurance 1st Intraoral
D0053 Little Teeth Insurance 2nd Intraoral
D0054 Little Teeth Insurance 2 Bitweings
D0055 Little Teeth Insurance Fluoride
D0120 Periodic oral Evaluation
D0140 Limit oral eval problm focus
D0145 "Oral evaluation pt < 3yrs"
D0150 Comprehensve oral evaluation
D0210 Intraor complete film series
D0220 Intraoral periapical first f
D0230 Intraoral periapical ea add
D0240 Intraoral occlusal film
D0250 Extraoral first film
D0270 Dental bitewing single film
D0272 Dental bitewings two films
D0273 Dental bitewings three films
D0274 Dental bitewings four films
D0320 Dental tmj arthrogram incl i
D0321 Dental other tmj films
D0322 Dental tomographic survey
D0330 Dental panoramic film
D0340 Dental cephalometric film
D0350 Oral/facial photo images
D0470 Diagnostic casts
D0474 Micro w exam of surg margins
D0486 Accession of brush biopsy
D0502 Other oral pathology procedu
D1110 Dental prophylaxis adult
D1120 Dental prophylaxis child
D1203 Topical app fluoride child
D1206 Topical fluoride varnish
D1208 Topical application of fluoride
D1320 Tobacco counseling
D1351 Dental sealant per tooth
D1352 Preventive Resin Restoration
D1353 Sealant Repair per tooth
D1354 Interim caries arresting medicament application per tooth
D1510 "Fixed unilateral per quadrant. Excludes a distal shoe space maintainer"
D1516 "Space Maintainerfixed bilateral maxillary"
D1517 "Space Maintainerfixed bilateral mandibular"
D1520 "Space Maintainer removable unilateral per quadrant"
D1526 "Space MaintainerRemovablebilateral maxillary"
D1527 "Space MaintainerRemovablebilateral mandibular"
D1551 Recement or rebond bilateral space maintainer maxillary
D1552 Recement or rebond bilateral space maintainer mandibular
D1553 Recement or rebond bilateral space maintainer per quadrant
D1555 Remove Fix Space Maintainer
D1575 "Distal Shoe space maintainerfixedunilateral per quadrant fabrication and delivery of fixed appliance extending subgingivally and distally to guide the eruption of the first permanent molar. Does not include ongoing followup or adjustments or replacement appliances once the tooth has erupted."
D2140 Amalgam one surface permanen
D2150 Amalgam two surfaces permane
D2160 Amalgam three surfaces perma
D2161 Amalgam 4 or > surfaces perm
D2330 Resin one surface‐anterior
D2331 Resin two surfaces‐anterior
D2332 Resin three surfaces‐anterio
D2335 Resin 4/> surf or w incis an
D2390 Ant resin‐based cmpst crown
D2391 Post 1 srfc resinbased cmpst
D2392 Post 2 srfc resinbased cmpst
D2393 Post 3 srfc resinbased cmpst
D2394 Post >=4srfc resinbase cmpst
D2740 Crown porcelain/ceramic substrate
D2751 Crown porcelain fused base m
D2791 Crown full cast base metal
D2920 Dental recement crown
D2930 Prefab stnlss steel crwn pri
D2931 Prefab stnlss steel crown pe
D2932 Prefabricated resin crown
D2940 Dental sedative filling
D2950 Core build‐up incl any pins
D2951 Tooth pin retention
D2952 Post and core cast + crown
D2954 Prefab post/core + crown
D3220 Therapeutic pulpotomy
D3230 Pulpal Therapy Anterior
D3240 Pulpal Therapy Posterior
D3310 "End thxpy anterior tooth"
D3320 "End thxpy bicuspid tooth"
D3330 "End thxpy molar"
D3346 Retreat root canal anterior
D3347 Retreat root canal bicuspid
D3348 Retreat root canal molar
D3351 Apexification/recalc initial
D3352 Apexification/recalc interim
D3353 Apexification/recalc final
D3410 Apicoect/perirad surg anter
D3421 Root surgery bicuspid
D4210 Gingivectomy/plasty per quad
D4211 Gingivectomy/plasty per toot
D4260 Osseous surgery per quadrant
D4261 Osseous surgl‐3teethperquad
D4341 Periodontal scaling & root
D4342 Periodontal scaling 1‐3teeth
D4346 Scaling Due To Inflammation
D4355 Full mouth debridement
D5110 Dentures complete maxillary
D5120 Dentures complete mandible
D5130 Dentures immediat maxillary
D5140 Dentures immediat mandible
D5213 Dentures maxill part metal
D5214 Dentures mandibl part metal
D5282 "Removable unilateral partial dentureone piece case metal (inclusing clasps and teeth) maxillary"
D5283 "Removable unilateral partial dentureone piece case metal (inclusing clasps and teeth) mandibular"
D5284 "Removable unilateral partial dentureone piece flexible base (inclusing clasps and teeth) per quadrant"
D5286 "Removable unilateral partial dentureone piece resin (inclusing clasps and teeth) per quadrant"
D5410 Dentures adjust cmplt maxil
D5411 Dentures adjust cmplt mand
D5421 Dentures adjust part maxill
D5422 Dentures adjust part mandbl
D5511 "Repair broken complete denture base mandibular"
D5512 "Repair broken complete denture base maxillary"
D5520 Replace denture teeth complt
D5611 "Repair resin partial denture base madibular"
D5612 "Repair resin partial denture base maxillary"
D5621 "Repair cast partial framework mandibular"
D5622 "Repair cast partial framework mandibular"
D5630 Repair or replace broken retentive/clasping materials per tooth
D5640 Replace part denture teeth
D5650 Add tooth to partial denture
D5660 Add clasp to partial denture
D5710 Dentures rebase cmplt maxil
D5711 Dentures rebase cmplt mand
D5720 Dentures rebase part maxill
D5721 Dentures rebase part mandbl
D5730 Denture reln cmplt maxil ch
D5731 Denture reln cmplt mand chr
D5740 Denture reln part maxil chr
D5741 Denture reln part mand chr
D5750 Denture reln cmplt max lab
D5751 Denture reln cmplt mand lab
D5760 Denture reln part maxil lab
D5761 Denture reln part mand lab
D5911 Facial moulage sectional
D5915 Orbital prosthesis
D5924 Cranial prosthesis
D5925 Facial augmentation implant
D5931 Surgical obturator
D5932 Postsurgical obturator
D5952 Pediatric speech aid
D5955 Palatal lift prosthesis
D5982 Surgical stent
D5986 Fluoride applicator
D6211 Bridge base metal cast
D6241 Bridge porcelain base metal
D6545 Dental retainr cast metl
D6930 Dental recement bridge
D7111 Extraction Cornoal Remnants
D7140 Extraction erupted tooth/exr
D7210 Surgical Extraction
D7220 Impact tooth remov soft tiss
D7230 Impact tooth remov part bony
D7240 Impact tooth remov comp bony
D7260 Oral antral fistula closure
D7270 Tooth reimplantation
D7280 Exposure impact tooth orthod
D7281 Exposure tooth aid eruption
D7283 Place device impacted tooth
D7285 Biopsy of oral tissue hard
D7286 Biopsy of oral tissue soft
D7310 Alveoplasty w/ extraction
D7320 Alveoplasty w/o extraction
D7340 Vestibuloplasty ridge extens
D7350 Vestibuloplasty exten graft
D7410 Rad exc lesion up to 1.25 cm
D7411 Excision benign lesion>1.25c
D7440 Malig tumor exc to 1.25 cm
D7441 Malig tumor > 1.25 cm
D7450 Rem odontogen cyst to 1.25cm
D7451 Rem odontogen cyst > 1.25 cm
D7460 Rem nonodonto cyst to 1.25cm
D7461 Rem nonodonto cyst > 1.25 cm
D7471 Rem exostosis any site
D7472 Removal of torus palatinus
D7473 Remove torus mandibularis
D7485 Surg reduct osseoustuberosit
D7490 Maxilla or mandible resectio
D7510 I&d absc intraoral soft tiss
D7520 I&d abscess extraoral
D7530 Removal fb skin/areolar tiss
D7550 Removal of sloughed off bone
D7560 Maxillary sinusotomy
D7610 Maxilla open reduct simple
D7620 Clsd reduct simpl maxilla fx
D7630 Open red simpl mandible fx
D7640 Clsd red simpl mandible fx
D7671 Alveolus open reduction
D7680 Facial bones complicated reduction with fixation and multiple surgical approaches
D7710 Maxilla open reduct compound
D7720 Clsd reduct compd maxilla fx
D7730 Open reduct compd mandble fx
D7740 Clsd reduct compd mandble fx
D7750 Open red comp malar/zygma fx
D7770 Open reduc compd alveolus fx
D7780 Reduct compnd facial bone fx
D7810 Tmj open reduct‐dislocation
D7820 Closed tmp manipulation
D7830 Tmj manipulation under anest
D7850 Tmj meniscectomy
D7852 Tmj repair of joint disc
D7858 Tmj reconstruction
D7865 Tmj reshaping components
D7870 Tmj aspiration joint fluid
D7872 Tmj diagnostic arthroscopy
D7873 Tmj arthroscopy lysis adhesn
D7874 Tmj arthroscopy disc reposit
D7876 Tmj arthroscopy discectomy
D7877 Tmj arthroscopy debridement
D7880 Occlusal orthotic appliance
D7899 Tmj unspecified therapy
D7910 Dent sutur recent wnd to 5cm
D7911 Dental suture wound to 5 cm
D7912 Suture complicate wnd > 5 cm
D7920 Dental skin graft
D7922 "Placement of intrasocket biological dressing to aid in hemostasis or clot stabilization per site"
D7941 Bone cutting ramus closed
D7943 Cutting ramus open w/graft
D7944 Bone cutting segmented
D7946 Reconstruction maxilla total
D7947 Reconstruct maxilla segment
D7948 Reconstruct midface no graft
D7949 Reconstruct midface w/graft
D7950 Mandible graft
D7955 Repair maxillofacial defects
D7960 Frenulectomy/frenulotomy
D7970 Excision hyperplastic tissue
D7979 Nonsurgical silaolithotomy
D7980 Sialolithotomy
D7981 Excision of salivary gland
D7982 Sialodochoplasty
D7991 Dental coronoidectomy
D8010 Limited dental tx primary
D8020 Limited dental tx transition
D8030 Limited dental tx adolescent
D8040 Limited dental tx adult
D8050 Intercep dental tx primary
D8060 Intercep dental tx transitn "
D8070 Compre dental tx transition "
D8080 Compre dental tx adolescent "
D8090 Compre dental tx adult
D8210 Orthodontic rem appliance tx
D8220 Fixed appliance therapy habt
D8680 Orthodontic retention
D8695 Removal of fixed orthodontic appliance(s) other than at conclusion of treatment
D8696 Repair of orthodontic appliance maxillary
D8697 Repair of orthodontic appliance mandibular
D8698 Recement or rebond fixed retainermaxillary
D8699 Recement or rebond fixed retainermandibular
D8701 "Repair of fixed retainer includes reattachmentmaxillary"
D8702 "Repair of fixed retainer includes reattachmentmandlbular"
D8703 Replacement of lost or broken retainermaxillary
D8704 Replacement of lost or broken retainermandibular
D9222 Deep sedation/general anesthesia first 15 minutes
D9223 Deep sedation/general anesthesia each 15 minute increment 0
D9230 Analgesia
D9239 Intravenous moderate (conscious) sedation/analgesia first 15 minutes
D9243 Intravenous moderate (conscious) sedation/analgesia each 15 minute increment 0
D9310 Dental consultation
D9420 Hospital call
D9630 Other drugs/medicaments
D9944 "Occlusal Guardhard appliance full arch"
D9945 "Occlusal Guardsoft appliance full arch"
D9946 "Occlusal Guardsoft appliance partial arch"
D9951 Limited occlusal adjustment
D9952 Complete occlusal adjustment
D9995 Teledentistry
TX CODE AND PRICE
TX CODE 2
D0001 Ortho Breakage
D0025 Antibiotics
D0030 MTA
D0035 Sedation Deposit
D0050 Little Teeth Insurance Exam
D0051 Little Teeth Insurance Prophy
D0052 Little Teeth Insurance 1st Intraoral
D0053 Little Teeth Insurance 2nd Intraoral
D0054 Little Teeth Insurance 2 Bitweings
D0055 Little Teeth Insurance Fluoride
D0120 Periodic oral Evaluation
D0140 Limit oral eval problm focus
D0145 "Oral evaluation pt < 3yrs"
D0150 Comprehensve oral evaluation
D0210 Intraor complete film series
D0220 Intraoral periapical first f
D0230 Intraoral periapical ea add
D0240 Intraoral occlusal film
D0250 Extraoral first film
D0270 Dental bitewing single film
D0272 Dental bitewings two films
D0273 Dental bitewings three films
D0274 Dental bitewings four films
D0320 Dental tmj arthrogram incl i
D0321 Dental other tmj films
D0322 Dental tomographic survey
D0330 Dental panoramic film
D0340 Dental cephalometric film
D0350 Oral/facial photo images
D0470 Diagnostic casts
D0474 Micro w exam of surg margins
D0486 Accession of brush biopsy
D0502 Other oral pathology procedu
D1110 Dental prophylaxis adult
D1120 Dental prophylaxis child
D1203 Topical app fluoride child
D1206 Topical fluoride varnish
D1208 Topical application of fluoride
D1320 Tobacco counseling
D1351 Dental sealant per tooth
D1352 Preventive Resin Restoration
D1353 Sealant Repair per tooth
D1354 Interim caries arresting medicament application per tooth
D1510 "Fixed unilateral per quadrant. Excludes a distal shoe space maintainer"
D1516 "Space Maintainerfixed bilateral maxillary"
D1517 "Space Maintainerfixed bilateral mandibular"
D1520 "Space Maintainer removable unilateral per quadrant"
D1526 "Space MaintainerRemovablebilateral maxillary"
D1527 "Space MaintainerRemovablebilateral mandibular"
D1551 Recement or rebond bilateral space maintainer maxillary
D1552 Recement or rebond bilateral space maintainer mandibular
D1553 Recement or rebond bilateral space maintainer per quadrant
D1555 Remove Fix Space Maintainer
D1575 "Distal Shoe space maintainerfixedunilateral per quadrant fabrication and delivery of fixed appliance extending subgingivally and distally to guide the eruption of the first permanent molar. Does not include ongoing followup or adjustments or replacement appliances once the tooth has erupted."
D2140 Amalgam one surface permanen
D2150 Amalgam two surfaces permane
D2160 Amalgam three surfaces perma
D2161 Amalgam 4 or > surfaces perm
D2330 Resin one surface‐anterior
D2331 Resin two surfaces‐anterior
D2332 Resin three surfaces‐anterio
D2335 Resin 4/> surf or w incis an
D2390 Ant resin‐based cmpst crown
D2391 Post 1 srfc resinbased cmpst
D2392 Post 2 srfc resinbased cmpst
D2393 Post 3 srfc resinbased cmpst
D2394 Post >=4srfc resinbase cmpst
D2740 Crown porcelain/ceramic substrate
D2751 Crown porcelain fused base m
D2791 Crown full cast base metal
D2920 Dental recement crown
D2930 Prefab stnlss steel crwn pri
D2931 Prefab stnlss steel crown pe
D2932 Prefabricated resin crown
D2940 Dental sedative filling
D2950 Core build‐up incl any pins
D2951 Tooth pin retention
D2952 Post and core cast + crown
D2954 Prefab post/core + crown
D3220 Therapeutic pulpotomy
D3230 Pulpal Therapy Anterior
D3240 Pulpal Therapy Posterior
D3310 "End thxpy anterior tooth"
D3320 "End thxpy bicuspid tooth"
D3330 "End thxpy molar"
D3346 Retreat root canal anterior
D3347 Retreat root canal bicuspid
D3348 Retreat root canal molar
D3351 Apexification/recalc initial
D3352 Apexification/recalc interim
D3353 Apexification/recalc final
D3410 Apicoect/perirad surg anter
D3421 Root surgery bicuspid
D4210 Gingivectomy/plasty per quad
D4211 Gingivectomy/plasty per toot
D4260 Osseous surgery per quadrant
D4261 Osseous surgl‐3teethperquad
D4341 Periodontal scaling & root
D4342 Periodontal scaling 1‐3teeth
D4346 Scaling Due To Inflammation
D4355 Full mouth debridement
D5110 Dentures complete maxillary
D5120 Dentures complete mandible
D5130 Dentures immediat maxillary
D5140 Dentures immediat mandible
D5213 Dentures maxill part metal
D5214 Dentures mandibl part metal
D5282 "Removable unilateral partial dentureone piece case metal (inclusing clasps and teeth) maxillary"
D5283 "Removable unilateral partial dentureone piece case metal (inclusing clasps and teeth) mandibular"
D5284 "Removable unilateral partial dentureone piece flexible base (inclusing clasps and teeth) per quadrant"
D5286 "Removable unilateral partial dentureone piece resin (inclusing clasps and teeth) per quadrant"
D5410 Dentures adjust cmplt maxil
D5411 Dentures adjust cmplt mand
D5421 Dentures adjust part maxill
D5422 Dentures adjust part mandbl
D5511 "Repair broken complete denture base mandibular"
D5512 "Repair broken complete denture base maxillary"
D5520 Replace denture teeth complt
D5611 "Repair resin partial denture base madibular"
D5612 "Repair resin partial denture base maxillary"
D5621 "Repair cast partial framework mandibular"
D5622 "Repair cast partial framework mandibular"
D5630 Repair or replace broken retentive/clasping materials per tooth
D5640 Replace part denture teeth
D5650 Add tooth to partial denture
D5660 Add clasp to partial denture
D5710 Dentures rebase cmplt maxil
D5711 Dentures rebase cmplt mand
D5720 Dentures rebase part maxill
D5721 Dentures rebase part mandbl
D5730 Denture reln cmplt maxil ch
D5731 Denture reln cmplt mand chr
D5740 Denture reln part maxil chr
D5741 Denture reln part mand chr
D5750 Denture reln cmplt max lab
D5751 Denture reln cmplt mand lab
D5760 Denture reln part maxil lab
D5761 Denture reln part mand lab
D5911 Facial moulage sectional
D5915 Orbital prosthesis
D5924 Cranial prosthesis
D5925 Facial augmentation implant
D5931 Surgical obturator
D5932 Postsurgical obturator
D5952 Pediatric speech aid
D5955 Palatal lift prosthesis
D5982 Surgical stent
D5986 Fluoride applicator
D6211 Bridge base metal cast
D6241 Bridge porcelain base metal
D6545 Dental retainr cast metl
D6930 Dental recement bridge
D7111 Extraction Cornoal Remnants
D7140 Extraction erupted tooth/exr
D7210 Surgical Extraction
D7220 Impact tooth remov soft tiss
D7230 Impact tooth remov part bony
D7240 Impact tooth remov comp bony
D7260 Oral antral fistula closure
D7270 Tooth reimplantation
D7280 Exposure impact tooth orthod
D7281 Exposure tooth aid eruption
D7283 Place device impacted tooth
D7285 Biopsy of oral tissue hard
D7286 Biopsy of oral tissue soft
D7310 Alveoplasty w/ extraction
D7320 Alveoplasty w/o extraction
D7340 Vestibuloplasty ridge extens
D7350 Vestibuloplasty exten graft
D7410 Rad exc lesion up to 1.25 cm
D7411 Excision benign lesion>1.25c
D7440 Malig tumor exc to 1.25 cm
D7441 Malig tumor > 1.25 cm
D7450 Rem odontogen cyst to 1.25cm
D7451 Rem odontogen cyst > 1.25 cm
D7460 Rem nonodonto cyst to 1.25cm
D7461 Rem nonodonto cyst > 1.25 cm
D7471 Rem exostosis any site
D7472 Removal of torus palatinus
D7473 Remove torus mandibularis
D7485 Surg reduct osseoustuberosit
D7490 Maxilla or mandible resectio
D7510 I&d absc intraoral soft tiss
D7520 I&d abscess extraoral
D7530 Removal fb skin/areolar tiss
D7550 Removal of sloughed off bone
D7560 Maxillary sinusotomy
D7610 Maxilla open reduct simple
D7620 Clsd reduct simpl maxilla fx
D7630 Open red simpl mandible fx
D7640 Clsd red simpl mandible fx
D7671 Alveolus open reduction
D7680 Facial bones complicated reduction with fixation and multiple surgical approaches
D7710 Maxilla open reduct compound
D7720 Clsd reduct compd maxilla fx
D7730 Open reduct compd mandble fx
D7740 Clsd reduct compd mandble fx
D7750 Open red comp malar/zygma fx
D7770 Open reduc compd alveolus fx
D7780 Reduct compnd facial bone fx
D7810 Tmj open reduct‐dislocation
D7820 Closed tmp manipulation
D7830 Tmj manipulation under anest
D7850 Tmj meniscectomy
D7852 Tmj repair of joint disc
D7858 Tmj reconstruction
D7865 Tmj reshaping components
D7870 Tmj aspiration joint fluid
D7872 Tmj diagnostic arthroscopy
D7873 Tmj arthroscopy lysis adhesn
D7874 Tmj arthroscopy disc reposit
D7876 Tmj arthroscopy discectomy
D7877 Tmj arthroscopy debridement
D7880 Occlusal orthotic appliance
D7899 Tmj unspecified therapy
D7910 Dent sutur recent wnd to 5cm
D7911 Dental suture wound to 5 cm
D7912 Suture complicate wnd > 5 cm
D7920 Dental skin graft
D7922 "Placement of intrasocket biological dressing to aid in hemostasis or clot stabilization per site"
D7941 Bone cutting ramus closed
D7943 Cutting ramus open w/graft
D7944 Bone cutting segmented
D7946 Reconstruction maxilla total
D7947 Reconstruct maxilla segment
D7948 Reconstruct midface no graft
D7949 Reconstruct midface w/graft
D7950 Mandible graft
D7955 Repair maxillofacial defects
D7960 Frenulectomy/frenulotomy
D7970 Excision hyperplastic tissue
D7979 Nonsurgical silaolithotomy
D7980 Sialolithotomy
D7981 Excision of salivary gland
D7982 Sialodochoplasty
D7991 Dental coronoidectomy
D8010 Limited dental tx primary
D8020 Limited dental tx transition
D8030 Limited dental tx adolescent
D8040 Limited dental tx adult
D8050 Intercep dental tx primary
D8060 Intercep dental tx transitn "
D8070 Compre dental tx transition "
D8080 Compre dental tx adolescent "
D8090 Compre dental tx adult
D8210 Orthodontic rem appliance tx
D8220 Fixed appliance therapy habt
D8680 Orthodontic retention
D8695 Removal of fixed orthodontic appliance(s) other than at conclusion of treatment
D8696 Repair of orthodontic appliance maxillary
D8697 Repair of orthodontic appliance mandibular
D8698 Recement or rebond fixed retainermaxillary
D8699 Recement or rebond fixed retainermandibular
D8701 "Repair of fixed retainer includes reattachmentmaxillary"
D8702 "Repair of fixed retainer includes reattachmentmandlbular"
D8703 Replacement of lost or broken retainermaxillary
D8704 Replacement of lost or broken retainermandibular
D9222 Deep sedation/general anesthesia first 15 minutes
D9223 Deep sedation/general anesthesia each 15 minute increment 0
D9230 Analgesia
D9239 Intravenous moderate (conscious) sedation/analgesia first 15 minutes
D9243 Intravenous moderate (conscious) sedation/analgesia each 15 minute increment 0
D9310 Dental consultation
D9420 Hospital call
D9630 Other drugs/medicaments
D9944 "Occlusal Guardhard appliance full arch"
D9945 "Occlusal Guardsoft appliance full arch"
D9946 "Occlusal Guardsoft appliance partial arch"
D9951 Limited occlusal adjustment
D9952 Complete occlusal adjustment
D9995 Teledentistry
TX CODE AND PRICE
TX CODE 3
D0001 Ortho Breakage
D0025 Antibiotics
D0030 MTA
D0035 Sedation Deposit
D0050 Little Teeth Insurance Exam
D0051 Little Teeth Insurance Prophy
D0052 Little Teeth Insurance 1st Intraoral
D0053 Little Teeth Insurance 2nd Intraoral
D0054 Little Teeth Insurance 2 Bitweings
D0055 Little Teeth Insurance Fluoride
D0120 Periodic oral Evaluation
D0140 Limit oral eval problm focus
D0145 "Oral evaluation pt < 3yrs"
D0150 Comprehensve oral evaluation
D0210 Intraor complete film series
D0220 Intraoral periapical first f
D0230 Intraoral periapical ea add
D0240 Intraoral occlusal film
D0250 Extraoral first film
D0270 Dental bitewing single film
D0272 Dental bitewings two films
D0273 Dental bitewings three films
D0274 Dental bitewings four films
D0320 Dental tmj arthrogram incl i
D0321 Dental other tmj films
D0322 Dental tomographic survey
D0330 Dental panoramic film
D0340 Dental cephalometric film
D0350 Oral/facial photo images
D0470 Diagnostic casts
D0474 Micro w exam of surg margins
D0486 Accession of brush biopsy
D0502 Other oral pathology procedu
D1110 Dental prophylaxis adult
D1120 Dental prophylaxis child
D1203 Topical app fluoride child
D1206 Topical fluoride varnish
D1208 Topical application of fluoride
D1320 Tobacco counseling
D1351 Dental sealant per tooth
D1352 Preventive Resin Restoration
D1353 Sealant Repair per tooth
D1354 Interim caries arresting medicament application per tooth
D1510 "Fixed unilateral per quadrant. Excludes a distal shoe space maintainer"
D1516 "Space Maintainerfixed bilateral maxillary"
D1517 "Space Maintainerfixed bilateral mandibular"
D1520 "Space Maintainer removable unilateral per quadrant"
D1526 "Space MaintainerRemovablebilateral maxillary"
D1527 "Space MaintainerRemovablebilateral mandibular"
D1551 Recement or rebond bilateral space maintainer maxillary
D1552 Recement or rebond bilateral space maintainer mandibular
D1553 Recement or rebond bilateral space maintainer per quadrant
D1555 Remove Fix Space Maintainer
D1575 "Distal Shoe space maintainerfixedunilateral per quadrant fabrication and delivery of fixed appliance extending subgingivally and distally to guide the eruption of the first permanent molar. Does not include ongoing followup or adjustments or replacement appliances once the tooth has erupted."
D2140 Amalgam one surface permanen
D2150 Amalgam two surfaces permane
D2160 Amalgam three surfaces perma
D2161 Amalgam 4 or > surfaces perm
D2330 Resin one surface‐anterior
D2331 Resin two surfaces‐anterior
D2332 Resin three surfaces‐anterio
D2335 Resin 4/> surf or w incis an
D2390 Ant resin‐based cmpst crown
D2391 Post 1 srfc resinbased cmpst
D2392 Post 2 srfc resinbased cmpst
D2393 Post 3 srfc resinbased cmpst
D2394 Post >=4srfc resinbase cmpst
D2740 Crown porcelain/ceramic substrate
D2751 Crown porcelain fused base m
D2791 Crown full cast base metal
D2920 Dental recement crown
D2930 Prefab stnlss steel crwn pri
D2931 Prefab stnlss steel crown pe
D2932 Prefabricated resin crown
D2940 Dental sedative filling
D2950 Core build‐up incl any pins
D2951 Tooth pin retention
D2952 Post and core cast + crown
D2954 Prefab post/core + crown
D3220 Therapeutic pulpotomy
D3230 Pulpal Therapy Anterior
D3240 Pulpal Therapy Posterior
D3310 "End thxpy anterior tooth"
D3320 "End thxpy bicuspid tooth"
D3330 "End thxpy molar"
D3346 Retreat root canal anterior
D3347 Retreat root canal bicuspid
D3348 Retreat root canal molar
D3351 Apexification/recalc initial
D3352 Apexification/recalc interim
D3353 Apexification/recalc final
D3410 Apicoect/perirad surg anter
D3421 Root surgery bicuspid
D4210 Gingivectomy/plasty per quad
D4211 Gingivectomy/plasty per toot
D4260 Osseous surgery per quadrant
D4261 Osseous surgl‐3teethperquad
D4341 Periodontal scaling & root
D4342 Periodontal scaling 1‐3teeth
D4346 Scaling Due To Inflammation
D4355 Full mouth debridement
D5110 Dentures complete maxillary
D5120 Dentures complete mandible
D5130 Dentures immediat maxillary
D5140 Dentures immediat mandible
D5213 Dentures maxill part metal
D5214 Dentures mandibl part metal
D5282 "Removable unilateral partial dentureone piece case metal (inclusing clasps and teeth) maxillary"
D5283 "Removable unilateral partial dentureone piece case metal (inclusing clasps and teeth) mandibular"
D5284 "Removable unilateral partial dentureone piece flexible base (inclusing clasps and teeth) per quadrant"
D5286 "Removable unilateral partial dentureone piece resin (inclusing clasps and teeth) per quadrant"
D5410 Dentures adjust cmplt maxil
D5411 Dentures adjust cmplt mand
D5421 Dentures adjust part maxill
D5422 Dentures adjust part mandbl
D5511 "Repair broken complete denture base mandibular"
D5512 "Repair broken complete denture base maxillary"
D5520 Replace denture teeth complt
D5611 "Repair resin partial denture base madibular"
D5612 "Repair resin partial denture base maxillary"
D5621 "Repair cast partial framework mandibular"
D5622 "Repair cast partial framework mandibular"
D5630 Repair or replace broken retentive/clasping materials per tooth
D5640 Replace part denture teeth
D5650 Add tooth to partial denture
D5660 Add clasp to partial denture
D5710 Dentures rebase cmplt maxil
D5711 Dentures rebase cmplt mand
D5720 Dentures rebase part maxill
D5721 Dentures rebase part mandbl
D5730 Denture reln cmplt maxil ch
D5731 Denture reln cmplt mand chr
D5740 Denture reln part maxil chr
D5741 Denture reln part mand chr
D5750 Denture reln cmplt max lab
D5751 Denture reln cmplt mand lab
D5760 Denture reln part maxil lab
D5761 Denture reln part mand lab
D5911 Facial moulage sectional
D5915 Orbital prosthesis
D5924 Cranial prosthesis
D5925 Facial augmentation implant
D5931 Surgical obturator
D5932 Postsurgical obturator
D5952 Pediatric speech aid
D5955 Palatal lift prosthesis
D5982 Surgical stent
D5986 Fluoride applicator
D6211 Bridge base metal cast
D6241 Bridge porcelain base metal
D6545 Dental retainr cast metl
D6930 Dental recement bridge
D7111 Extraction Cornoal Remnants
D7140 Extraction erupted tooth/exr
D7210 Surgical Extraction
D7220 Impact tooth remov soft tiss
D7230 Impact tooth remov part bony
D7240 Impact tooth remov comp bony
D7260 Oral antral fistula closure
D7270 Tooth reimplantation
D7280 Exposure impact tooth orthod
D7281 Exposure tooth aid eruption
D7283 Place device impacted tooth
D7285 Biopsy of oral tissue hard
D7286 Biopsy of oral tissue soft
D7310 Alveoplasty w/ extraction
D7320 Alveoplasty w/o extraction
D7340 Vestibuloplasty ridge extens
D7350 Vestibuloplasty exten graft
D7410 Rad exc lesion up to 1.25 cm
D7411 Excision benign lesion>1.25c
D7440 Malig tumor exc to 1.25 cm
D7441 Malig tumor > 1.25 cm
D7450 Rem odontogen cyst to 1.25cm
D7451 Rem odontogen cyst > 1.25 cm
D7460 Rem nonodonto cyst to 1.25cm
D7461 Rem nonodonto cyst > 1.25 cm
D7471 Rem exostosis any site
D7472 Removal of torus palatinus
D7473 Remove torus mandibularis
D7485 Surg reduct osseoustuberosit
D7490 Maxilla or mandible resectio
D7510 I&d absc intraoral soft tiss
D7520 I&d abscess extraoral
D7530 Removal fb skin/areolar tiss
D7550 Removal of sloughed off bone
D7560 Maxillary sinusotomy
D7610 Maxilla open reduct simple
D7620 Clsd reduct simpl maxilla fx
D7630 Open red simpl mandible fx
D7640 Clsd red simpl mandible fx
D7671 Alveolus open reduction
D7680 Facial bones complicated reduction with fixation and multiple surgical approaches
D7710 Maxilla open reduct compound
D7720 Clsd reduct compd maxilla fx
D7730 Open reduct compd mandble fx
D7740 Clsd reduct compd mandble fx
D7750 Open red comp malar/zygma fx
D7770 Open reduc compd alveolus fx
D7780 Reduct compnd facial bone fx
D7810 Tmj open reduct‐dislocation
D7820 Closed tmp manipulation
D7830 Tmj manipulation under anest
D7850 Tmj meniscectomy
D7852 Tmj repair of joint disc
D7858 Tmj reconstruction
D7865 Tmj reshaping components
D7870 Tmj aspiration joint fluid
D7872 Tmj diagnostic arthroscopy
D7873 Tmj arthroscopy lysis adhesn
D7874 Tmj arthroscopy disc reposit
D7876 Tmj arthroscopy discectomy
D7877 Tmj arthroscopy debridement
D7880 Occlusal orthotic appliance
D7899 Tmj unspecified therapy
D7910 Dent sutur recent wnd to 5cm
D7911 Dental suture wound to 5 cm
D7912 Suture complicate wnd > 5 cm
D7920 Dental skin graft
D7922 "Placement of intrasocket biological dressing to aid in hemostasis or clot stabilization per site"
D7941 Bone cutting ramus closed
D7943 Cutting ramus open w/graft
D7944 Bone cutting segmented
D7946 Reconstruction maxilla total
D7947 Reconstruct maxilla segment
D7948 Reconstruct midface no graft
D7949 Reconstruct midface w/graft
D7950 Mandible graft
D7955 Repair maxillofacial defects
D7960 Frenulectomy/frenulotomy
D7970 Excision hyperplastic tissue
D7979 Nonsurgical silaolithotomy
D7980 Sialolithotomy
D7981 Excision of salivary gland
D7982 Sialodochoplasty
D7991 Dental coronoidectomy
D8010 Limited dental tx primary
D8020 Limited dental tx transition
D8030 Limited dental tx adolescent
D8040 Limited dental tx adult
D8050 Intercep dental tx primary
D8060 Intercep dental tx transitn "
D8070 Compre dental tx transition "
D8080 Compre dental tx adolescent "
D8090 Compre dental tx adult
D8210 Orthodontic rem appliance tx
D8220 Fixed appliance therapy habt
D8680 Orthodontic retention
D8695 Removal of fixed orthodontic appliance(s) other than at conclusion of treatment
D8696 Repair of orthodontic appliance maxillary
D8697 Repair of orthodontic appliance mandibular
D8698 Recement or rebond fixed retainermaxillary
D8699 Recement or rebond fixed retainermandibular
D8701 "Repair of fixed retainer includes reattachmentmaxillary"
D8702 "Repair of fixed retainer includes reattachmentmandlbular"
D8703 Replacement of lost or broken retainermaxillary
D8704 Replacement of lost or broken retainermandibular
D9222 Deep sedation/general anesthesia first 15 minutes
D9223 Deep sedation/general anesthesia each 15 minute increment 0
D9230 Analgesia
D9239 Intravenous moderate (conscious) sedation/analgesia first 15 minutes
D9243 Intravenous moderate (conscious) sedation/analgesia each 15 minute increment 0
D9310 Dental consultation
D9420 Hospital call
D9630 Other drugs/medicaments
D9944 "Occlusal Guardhard appliance full arch"
D9945 "Occlusal Guardsoft appliance full arch"
D9946 "Occlusal Guardsoft appliance partial arch"
D9951 Limited occlusal adjustment
D9952 Complete occlusal adjustment
D9995 Teledentistry
TX CODE AND PRICE
TX CODE 4
D0001 Ortho Breakage
D0025 Antibiotics
D0030 MTA
D0035 Sedation Deposit
D0050 Little Teeth Insurance Exam
D0051 Little Teeth Insurance Prophy
D0052 Little Teeth Insurance 1st Intraoral
D0053 Little Teeth Insurance 2nd Intraoral
D0054 Little Teeth Insurance 2 Bitweings
D0055 Little Teeth Insurance Fluoride
D0120 Periodic oral Evaluation
D0140 Limit oral eval problm focus
D0145 "Oral evaluation pt < 3yrs"
D0150 Comprehensve oral evaluation
D0210 Intraor complete film series
D0220 Intraoral periapical first f
D0230 Intraoral periapical ea add
D0240 Intraoral occlusal film
D0250 Extraoral first film
D0270 Dental bitewing single film
D0272 Dental bitewings two films
D0273 Dental bitewings three films
D0274 Dental bitewings four films
D0320 Dental tmj arthrogram incl i
D0321 Dental other tmj films
D0322 Dental tomographic survey
D0330 Dental panoramic film
D0340 Dental cephalometric film
D0350 Oral/facial photo images
D0470 Diagnostic casts
D0474 Micro w exam of surg margins
D0486 Accession of brush biopsy
D0502 Other oral pathology procedu
D1110 Dental prophylaxis adult
D1120 Dental prophylaxis child
D1203 Topical app fluoride child
D1206 Topical fluoride varnish
D1208 Topical application of fluoride
D1320 Tobacco counseling
D1351 Dental sealant per tooth
D1352 Preventive Resin Restoration
D1353 Sealant Repair per tooth
D1354 Interim caries arresting medicament application per tooth
D1510 "Fixed unilateral per quadrant. Excludes a distal shoe space maintainer"
D1516 "Space Maintainerfixed bilateral maxillary"
D1517 "Space Maintainerfixed bilateral mandibular"
D1520 "Space Maintainer removable unilateral per quadrant"
D1526 "Space MaintainerRemovablebilateral maxillary"
D1527 "Space MaintainerRemovablebilateral mandibular"
D1551 Recement or rebond bilateral space maintainer maxillary
D1552 Recement or rebond bilateral space maintainer mandibular
D1553 Recement or rebond bilateral space maintainer per quadrant
D1555 Remove Fix Space Maintainer
D1575 "Distal Shoe space maintainerfixedunilateral per quadrant fabrication and delivery of fixed appliance extending subgingivally and distally to guide the eruption of the first permanent molar. Does not include ongoing followup or adjustments or replacement appliances once the tooth has erupted."
D2140 Amalgam one surface permanen
D2150 Amalgam two surfaces permane
D2160 Amalgam three surfaces perma
D2161 Amalgam 4 or > surfaces perm
D2330 Resin one surface‐anterior
D2331 Resin two surfaces‐anterior
D2332 Resin three surfaces‐anterio
D2335 Resin 4/> surf or w incis an
D2390 Ant resin‐based cmpst crown
D2391 Post 1 srfc resinbased cmpst
D2392 Post 2 srfc resinbased cmpst
D2393 Post 3 srfc resinbased cmpst
D2394 Post >=4srfc resinbase cmpst
D2740 Crown porcelain/ceramic substrate
D2751 Crown porcelain fused base m
D2791 Crown full cast base metal
D2920 Dental recement crown
D2930 Prefab stnlss steel crwn pri
D2931 Prefab stnlss steel crown pe
D2932 Prefabricated resin crown
D2940 Dental sedative filling
D2950 Core build‐up incl any pins
D2951 Tooth pin retention
D2952 Post and core cast + crown
D2954 Prefab post/core + crown
D3220 Therapeutic pulpotomy
D3230 Pulpal Therapy Anterior
D3240 Pulpal Therapy Posterior
D3310 "End thxpy anterior tooth"
D3320 "End thxpy bicuspid tooth"
D3330 "End thxpy molar"
D3346 Retreat root canal anterior
D3347 Retreat root canal bicuspid
D3348 Retreat root canal molar
D3351 Apexification/recalc initial
D3352 Apexification/recalc interim
D3353 Apexification/recalc final
D3410 Apicoect/perirad surg anter
D3421 Root surgery bicuspid
D4210 Gingivectomy/plasty per quad
D4211 Gingivectomy/plasty per toot
D4260 Osseous surgery per quadrant
D4261 Osseous surgl‐3teethperquad
D4341 Periodontal scaling & root
D4342 Periodontal scaling 1‐3teeth
D4346 Scaling Due To Inflammation
D4355 Full mouth debridement
D5110 Dentures complete maxillary
D5120 Dentures complete mandible
D5130 Dentures immediat maxillary
D5140 Dentures immediat mandible
D5213 Dentures maxill part metal
D5214 Dentures mandibl part metal
D5282 "Removable unilateral partial dentureone piece case metal (inclusing clasps and teeth) maxillary"
D5283 "Removable unilateral partial dentureone piece case metal (inclusing clasps and teeth) mandibular"
D5284 "Removable unilateral partial dentureone piece flexible base (inclusing clasps and teeth) per quadrant"
D5286 "Removable unilateral partial dentureone piece resin (inclusing clasps and teeth) per quadrant"
D5410 Dentures adjust cmplt maxil
D5411 Dentures adjust cmplt mand
D5421 Dentures adjust part maxill
D5422 Dentures adjust part mandbl
D5511 "Repair broken complete denture base mandibular"
D5512 "Repair broken complete denture base maxillary"
D5520 Replace denture teeth complt
D5611 "Repair resin partial denture base madibular"
D5612 "Repair resin partial denture base maxillary"
D5621 "Repair cast partial framework mandibular"
D5622 "Repair cast partial framework mandibular"
D5630 Repair or replace broken retentive/clasping materials per tooth
D5640 Replace part denture teeth
D5650 Add tooth to partial denture
D5660 Add clasp to partial denture
D5710 Dentures rebase cmplt maxil
D5711 Dentures rebase cmplt mand
D5720 Dentures rebase part maxill
D5721 Dentures rebase part mandbl
D5730 Denture reln cmplt maxil ch
D5731 Denture reln cmplt mand chr
D5740 Denture reln part maxil chr
D5741 Denture reln part mand chr
D5750 Denture reln cmplt max lab
D5751 Denture reln cmplt mand lab
D5760 Denture reln part maxil lab
D5761 Denture reln part mand lab
D5911 Facial moulage sectional
D5915 Orbital prosthesis
D5924 Cranial prosthesis
D5925 Facial augmentation implant
D5931 Surgical obturator
D5932 Postsurgical obturator
D5952 Pediatric speech aid
D5955 Palatal lift prosthesis
D5982 Surgical stent
D5986 Fluoride applicator
D6211 Bridge base metal cast
D6241 Bridge porcelain base metal
D6545 Dental retainr cast metl
D6930 Dental recement bridge
D7111 Extraction Cornoal Remnants
D7140 Extraction erupted tooth/exr
D7210 Surgical Extraction
D7220 Impact tooth remov soft tiss
D7230 Impact tooth remov part bony
D7240 Impact tooth remov comp bony
D7260 Oral antral fistula closure
D7270 Tooth reimplantation
D7280 Exposure impact tooth orthod
D7281 Exposure tooth aid eruption
D7283 Place device impacted tooth
D7285 Biopsy of oral tissue hard
D7286 Biopsy of oral tissue soft
D7310 Alveoplasty w/ extraction
D7320 Alveoplasty w/o extraction
D7340 Vestibuloplasty ridge extens
D7350 Vestibuloplasty exten graft
D7410 Rad exc lesion up to 1.25 cm
D7411 Excision benign lesion>1.25c
D7440 Malig tumor exc to 1.25 cm
D7441 Malig tumor > 1.25 cm
D7450 Rem odontogen cyst to 1.25cm
D7451 Rem odontogen cyst > 1.25 cm
D7460 Rem nonodonto cyst to 1.25cm
D7461 Rem nonodonto cyst > 1.25 cm
D7471 Rem exostosis any site
D7472 Removal of torus palatinus
D7473 Remove torus mandibularis
D7485 Surg reduct osseoustuberosit
D7490 Maxilla or mandible resectio
D7510 I&d absc intraoral soft tiss
D7520 I&d abscess extraoral
D7530 Removal fb skin/areolar tiss
D7550 Removal of sloughed off bone
D7560 Maxillary sinusotomy
D7610 Maxilla open reduct simple
D7620 Clsd reduct simpl maxilla fx
D7630 Open red simpl mandible fx
D7640 Clsd red simpl mandible fx
D7671 Alveolus open reduction
D7680 Facial bones complicated reduction with fixation and multiple surgical approaches
D7710 Maxilla open reduct compound
D7720 Clsd reduct compd maxilla fx
D7730 Open reduct compd mandble fx
D7740 Clsd reduct compd mandble fx
D7750 Open red comp malar/zygma fx
D7770 Open reduc compd alveolus fx
D7780 Reduct compnd facial bone fx
D7810 Tmj open reduct‐dislocation
D7820 Closed tmp manipulation
D7830 Tmj manipulation under anest
D7850 Tmj meniscectomy
D7852 Tmj repair of joint disc
D7858 Tmj reconstruction
D7865 Tmj reshaping components
D7870 Tmj aspiration joint fluid
D7872 Tmj diagnostic arthroscopy
D7873 Tmj arthroscopy lysis adhesn
D7874 Tmj arthroscopy disc reposit
D7876 Tmj arthroscopy discectomy
D7877 Tmj arthroscopy debridement
D7880 Occlusal orthotic appliance
D7899 Tmj unspecified therapy
D7910 Dent sutur recent wnd to 5cm
D7911 Dental suture wound to 5 cm
D7912 Suture complicate wnd > 5 cm
D7920 Dental skin graft
D7922 "Placement of intrasocket biological dressing to aid in hemostasis or clot stabilization per site"
D7941 Bone cutting ramus closed
D7943 Cutting ramus open w/graft
D7944 Bone cutting segmented
D7946 Reconstruction maxilla total
D7947 Reconstruct maxilla segment
D7948 Reconstruct midface no graft
D7949 Reconstruct midface w/graft
D7950 Mandible graft
D7955 Repair maxillofacial defects
D7960 Frenulectomy/frenulotomy
D7970 Excision hyperplastic tissue
D7979 Nonsurgical silaolithotomy
D7980 Sialolithotomy
D7981 Excision of salivary gland
D7982 Sialodochoplasty
D7991 Dental coronoidectomy
D8010 Limited dental tx primary
D8020 Limited dental tx transition
D8030 Limited dental tx adolescent
D8040 Limited dental tx adult
D8050 Intercep dental tx primary
D8060 Intercep dental tx transitn "
D8070 Compre dental tx transition "
D8080 Compre dental tx adolescent "
D8090 Compre dental tx adult
D8210 Orthodontic rem appliance tx
D8220 Fixed appliance therapy habt
D8680 Orthodontic retention
D8695 Removal of fixed orthodontic appliance(s) other than at conclusion of treatment
D8696 Repair of orthodontic appliance maxillary
D8697 Repair of orthodontic appliance mandibular
D8698 Recement or rebond fixed retainermaxillary
D8699 Recement or rebond fixed retainermandibular
D8701 "Repair of fixed retainer includes reattachmentmaxillary"
D8702 "Repair of fixed retainer includes reattachmentmandlbular"
D8703 Replacement of lost or broken retainermaxillary
D8704 Replacement of lost or broken retainermandibular
D9222 Deep sedation/general anesthesia first 15 minutes
D9223 Deep sedation/general anesthesia each 15 minute increment 0
D9230 Analgesia
D9239 Intravenous moderate (conscious) sedation/analgesia first 15 minutes
D9243 Intravenous moderate (conscious) sedation/analgesia each 15 minute increment 0
D9310 Dental consultation
D9420 Hospital call
D9630 Other drugs/medicaments
D9944 "Occlusal Guardhard appliance full arch"
D9945 "Occlusal Guardsoft appliance full arch"
D9946 "Occlusal Guardsoft appliance partial arch"
D9951 Limited occlusal adjustment
D9952 Complete occlusal adjustment
D9995 Teledentistry
TX CODE AND PRICE
Description
Discount 10%
Price:
$0.00
Discount and Total
Total
$0.00
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