Code

Procedure description

DM/+L

MP

TC

General Dental Practice

(054)

Maxillo-facial and Oral Surgery

(062)

Prosthodontics

(094)

F.  PROSTHODONTICS (REMOVABLE)

8231

Full upper and lower dentures inclusive of soft base or metal base, where applicable

+L

M

B

3154.33

-

4731.50

8232

Full upper or lower dentures inclusive of soft base or metal base, where applicable

+L

M

B

1944.18

-

2916.26

8244

Immediate denture - maxillary

+L

M

B

1681.70

-

2522.80

A removable complete denture constructed for placement immediately after removal of the remaining natural teeth. This procedure includes limited followup care only and excludes subsequent rebasing/relining procedure(s) and/or the replacement with new complete denture.

See interim prosthesis for immediate and/ or provisional partial dentures.

8245

Immediate denture - mandibular

See tariff code 8244 for descriptor

+L

M

B

1681.70

-

2522.80

8246

Immediate denture - partial

Report in addition to tariff codes for partial denture tariff codes 8233 - 8241

+L

T

B

1177.20

-

1765.90

8643

Complete dentures - maxillary and mandibular (with complications)

+L

B

-

-

9735.19

8645

Complete upper and lower dentures with major complications

+L

B

-

-

11973.77

8649

Complete dentures - maxillary and mandibular (with complications)

+L

M

B

-

-

5994.86

8651

Complete upper and lower dentures with major complications

+L

M

B

-

-

6742.01

PARTIAL DENTURES (including routine post-delivery care)

8233

Partial denture, one tooth

+L

M

B

903.02

-

903.02

8234

Partial denture, two teeth

+L

M

B

903.02

-

903.02

8235

Partial denture, three teeth

+L

M

B

1349.89

-

1349.89

8236

Partial denture, four teeth

+L

M

B

1349.89

-

1349.89

8237

Partial denture, five teeth

+L

M

B

1349.89

-

1349.89

8238

Partial denture, six teeth

+L

M

B

1799.40

-

1799.40

8239

Partial denture, seven teeth

+L

M

B

1799.40

-

1799.40

8240

Partial denture, eight teeth

+L

M

B

1799.40

-

1799.40

8241

Partial denture, nine or more teeth

+L

M

B

1799.40

-

1799.40

8281

Metal (e.g. chrome cobalt, etc.) base to partial denture, per denture

+L

M

B

2402.35

-

2402.35

The procedure refers to the metal framework only, and includes all clasps, rests and bars (i.e. tariff codes 8251, 8253, 8255 and 8257). See tariff codes 8233 to 8241 for the resin denture base required concurrent to tariff code 8281

8671

Metal (e.g. Chrome cobalt or gold) partial denture

+L

M

A

-

-

5994.86

Adjustments to dentures

8275

Adjust complete or partial denture

136.33

-

139.14

After six months or for patient of another practitioner

8662

Remounting and occlusal adjustment of dentures

+L

B

-

-

862.90

Repairs to complete or partial dentures

Professional fees should not be levied for the repair of dentures/intra-oral appliances if the practitioner did not examine the patient. Laboratory costs, however, may be recovered.

8269

Repair of denture or other intra-oral appliance

+L

M

B

258.65

-

303.90

See tariff code 8273 (Impression to repair/modify a denture)

8270

Add clasp to existing partial denture (One or more clasps)

Tariff code 8270 is in addition to tariff code 8269.

+L

M

B

171.22

-

171.22

One or more clasps. Tariff code 8270 may be reported in addition to tariff code 8269. See tariff code 8273 (Impression to repair/modify a denture).

8271

Add tooth to existing partial denture (One or more teeth)

Tariff code 8271 is in addition to tariff code 8269.

+L

M

B

171.22

-

171.22

One or more teeth. Tariff code 8271 may be reported in addition to tariff code 8269. See tariff code 8273

(Impression to repair/modify a denture).

8273

Impression to repair or modify a denture or other intra-oral appliance

+L

B

136.30

-

139.14

May be reported in addition to the appropriate tariff code in this subsection when an impression is required. Includes any number of impressions.

DENTURE REBASE PROCEDURES

Rebase - The partial or complete removal and replacement of the denture base.

8259

Re-base of denture (laboratory)

+L

M

B

742.72

-

1114.07

8261

Re-model of denture

+L

M

B

1219.63

-

1219.63

DENTURE RELINE PROCEDURES

Reline - The addition of material to the fitting surface of a denture base

8263

Reline of denture in selfcuring acrylic (intra-oral)

M

B

464.02

-

696.03

8267

Reline complete or partial denture (laboratory)

+L

M

B

1070.61

-

1070.61

Soft base re-line per denture (heat cured) tariff code 8267 may not be charged concurrent with tariff codes 8231 to 8241

OTHER REMOVABLE PROSTHETIC PROCEDURES

8255

Stainless steel clasp or rest, per clasp or rest

+L

B

186.34

-

186.34

Tariff codes 8255, 8257 may not be charged concurrent with tariff codes 8269 (repair of denture) or 8281 (metal framework)

8257

Lingual bar or palatal bar

+L

M

B

225.46

-

225.46

8265

Tissue conditioner and soft self-cure interim re-line, per denture

308.14

-

462.21