I

GENERAL DENTAL PRACTITIONERS

(1).

PREAMBLE

The dental procedure codes for general dental practitioners are divided into twelve (12) categories of services. The procedures have been grouped according to the category with which the procedures are most frequently identified.  The categories are created solely for convenience in using the schedule and should not be interpreted as excluding certain types of Oral Care Providers from performing or reporting such procedures. These categories are similar to that in the "Current Dental Terminology" Third Edition (CDT-3).

(2).

(M/W)

Procedures not described in the general practitioner's schedule should be reported by referring to the relevant specialist's schedule. Dentists in general practice shall be entitled to charge two-thirds of the fees of specialists only for treatment codes that are not listed in the schedule for dentists in general practice. (See Rules 009 and 011).

(3).

(M/W)

Oral and maxillofacial surgery (Section J of the Schedule): The fee payable to a general practitioner assistant shall be calculated as 15% of the fee of the practitioner performing the operation, with the indicated minimum (see Modifier 8007). The Compensation Fund must be informed beforehand that another dentist will be assisting at the operation and that a fee will be payable to the assistant. The assistant's name must appear on the invoice rendered to the Compensation Fund.

Code

Procedure description

DM/+L

MP

TC

General Dental Practice

(054)

Maxillo-facial and Oral Surgery

(062)

Prosthodontics

(094)

A. DIAGNOSTIC

Clinical oral evaluation

8101

Oral examination

(charting and treatment planning (see Rule 001)

B

333.55

-

-

An assessment performed on a patient to determine the patient's dental and medical health status involving an examination,diagnosis and treatment plan. It is a thorough assessment and recording of the patient's current state of oral health (extraoral and

intraoral hard and soft tissues), risk for future dental disease as well as assessing general health factors that relate to the treatment of the patient. This procedure is also used to report a periodic examination on an established patient to determine any changes in a patient's dental and medical health status since a previous periodic or comprehensive examination.

No further oral examination fees shall be levied until the treatment plan resulting from this assessment is completed (See Rule 001).

8102

Comprehensive oral examination

B

435.39

-

-

An assessment performed on a new or established patient (patient of record) to determine the patient's dental and medical health status involving a comprehensive examination, diagnosis and treatment plan.

It is a thorough assessment and recording of the patient's past and current state of oral health (extraoral and intraoral hard and soft tissues), risk for future dental disease as well as assessing general health factors that relate to the treatment of the patient. A comprehensive examination includes treatment planning at a separate appointment where a diagnosis is made with information acquired through study models, full-mouth x-rays and other relevant diagnostic aids. It includes, but is not limited to the evaluation and recording of dental caries, pulp vitality tests of the complete dentition, plaque index, missing and unerupted teeth, restorations, occlusal relationships, periodontal conditions (including a periodontal charting and bleeding index), hard and soft tissue anomalies (including the TMJ).The patient shall be provided with a written comprehensive treatment plan,which is a part of the patient's clinical record and the original should be retained by the dentist.

No further oral examination fees shall be levied until the treatment plan resulting from this assessment is completed (See Rule 001)

8104

Examination or consultation for a specific problem not requiring a full mouth examination, charting and treatment planning

B

131.70

-

-

An assessment performed on a new or established patient (patient of record) involving an examination, diagnosis and treatment plan, limited to a specific oral health problem or complaint. This type of assessment is conducted on patients who present with a specific problem or during an emergency situation for the management of a critical dental condition (e.g., trauma and acute infections). It includes patients who have been referred for the management of a specific condition or treatment such as the removal of a tooth, a crown lengthening or isolated grafting procedure where there is no need for a comprehensive assessment.

Comment: This code should not be reported on established patients who present with specific problems/emergencies which is part of and/or a result of the patients' current treatment plan, e.g., recementation/replacement of temporary restorations, pain relief during root canal treatment, etc.

Radiographs/Diagnostic imaging

8107

Intraoral radiographs - periapical

B

127.25

127.25

127.25

Eight and more radiographs of any combination of tariff

codes 8107 and 8112 taken on the same date of service for diagnostic purposes are considered to be a complete intraoral series (8108) and should be submitted as such.

8108

Intraoral radiographs - complete series

B

957.08

1014.96

1014.96

A complete series consists of a minimum of eight intraoral radiographs, periapical and or bitewing, occlusal radiographs excluded

8112

Intraoral radiograph - bitewing

B

127.25

127.25

127.25

Eight and more radiographs of any combination of tariff codes 8107 and 8112 taken on the same date of service for diagnostic purposes are considered to be a complete intraoral series (8108) and should be submitted as such.

8113

Intraoral radiograph - occlusal

B

198.24

198.24

198.24

8115

Extraoral radiograph - panoramic

B

523.91

523.91

523.91

8116

Extraoral radiograph - cephalometric

B

523.91

523.91

523.91

8118

Extraoral radiograph - skull/facial bone

B

523.91

523.91

523.91

OTHER DIAGNOSTIC PROCEDURES

8117

Diagnostic models

+L

B

142.99

143.18

143.18

Also known as study models or diagnostic casts.Models used to aid diagnosis and treatment planning. Diagnostic models should be retained as part of the patient's clinical record and may only be used for diagnostic purposes. Includes diagnostic models mounted on a hinge articulator.

8119

Diagnostic models mounted

+L

B

367.64

367.64

367.64

See tariff code 8117. Report this tariff code when models are mounted on a movable condyle articulator.

8121

Oral and/or facial image (digital/conventional)

B

142.99

143.18

143.18

This includes traditional photographs and digital intra- or extraoral images obtained by intraoral cameras. These images should only be reported when taken for clinical/diagnostic reasons and shall be retained as part of the patient's clinical record.Excludes conventional radiographs.

8194

CBCT capture and interpretation with limited field of view - less than one whole jaw

M

A

428.30

428.30

428.30

8195

CBCT capture and interpretation with limited field of view of one full dental arch -mandible

M

A

428.30

428.30

428.30

8196

CBCT capture and interpretation with limited field of view of one full dental arch- maxilla without orbits and/or cranium

M

A

428.30

428.30

428.30

8197

CBCT capture and interpretation with limited field of view of both dental arches - without orbits and or cranium

M

A

428.30

428.30

428.30

8198

CBCT capture and interpretation for TMJ series including two or more exposures.

M

A

428.30

428.30

428.30

8199

CBCT capture and interpretation with limited field of view of one full dental arch- maxilla with orbits and/or cranium

M

A

428.30

428.30

428.30

8200

CBCT capture and interpretation with field of view of both dental arches - with orbits and/or cranium

M

A

428.30

428.30

428.30