DO230 COMMON DENTAL PROCEDURE CODES (Modified)
User Manual: DO230
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COMMON DENTAL PROCEDURE CODES USED IN DIRECT CARE PROGRAMS The Dental Data Reporting System of the IHS accepts all procedure codes listed in the Current Dental Terminology (CDT) published by the American Dental Association as well as unique codes (in boldface) created by the IHS. DO272 DO273 DO274 DO330 DO340 DO350 DO425 DO460 DO470 DO471 Use of exam codes: The 01 14 Screening Exam is used when no dental chart is made (e.g., large groups of school children). The DO140 Problem-focused Examination is limited to diagnosing a specific, urgent problem (dental emergency). It can be reported each time an individual presents with a problem, but not with other exam codes at the same appointment. The DO150 Comprehensive Exam includes the completion of a new oral health record, rather than updating an existing chart, which is when the DO120 Periodic Exam should be reported. The DO160 Extensive Problem-focused Exam may be used after a DO120 or DO150 has been recently reported, when patients require a detailed treatment plan for a specific problem (e.g., a case work-up for periodontics, prosthodontics, orthodontics or oral surgery). The DO160 evaluation may be documented on special forms in lieu of the oral health record used routinely for the DO120 and DO150 codes. The DO180 is used for comprehensive periodontal examinations of patients with signs or symptoms of periodontal disease or risk factors (e.g. diabetes, smoking). Bitewings, Two Films Bitewings, Three Films Bitewings, Four Films Panoramic-Maxilla And Mandible Film Cephalometric Film OrallFacial Images Caries Susceptibility Test Pulp Vitality Tests (Per Quad) Diagnostic Casts (Per Set) Diagnostic Photographs PREVENTIVE SERVICES D l 110 Prophylaxis, Adult (Permanent Dentition) D l 120 Prophylaxis, Child (Primary or Mixed Dentition) Dl203 Topical Fluoride Not Including Prophy-Child Dl204 Topical Fluoride Not Including Prophy-Adult Dl206 Topical Fluoride Varnish (mod to high risk pts) D l 310 Nutritional Counseling For Oral Health D l 320 Tobacco Use Counseling D l 330 Oral Hygiene Instructions D l 351 Sealant (per tooth) D l 510 Space Maintainer, Fixed Unilateral D l 515 Space Maintainer, Fixed Bilateral Dl550 Space Maintainer, Recementation D l 555 Removal of Fixed Space Maintainer PERSONS SERVED (ENCOUNTER CODES) 0000 First Visit (of fiscal year by the patient) Dental Revisit (For Any Reason) 0190 0003 BBTDIECC Dental Patient Head Start Program Dental Patient 0004 0007 High-risk Periodontal Patient 9320 Diabetic Screening Procedures 9321 Diabetic Referral Or Follow-up 9330 Hypertension Screening 9331 Hypertension Referral Or Follow-up 9340 Dental Visit, Pre-Natal Mother 9341 Dental Visit, Nursing Mother 9990 Planned Treatment Completed 9991 Patient Refuses Recommended Treatment . RESTORATIVE DENTISTRY DIAGNOSTIC SERVICES DO120 Periodic Oral Evaluation (update existing chart) DO140 Limited Evaluation-Problem Focused (Emerg. Exam: DO145 Oral Evaluation for Patient under 3 years of age DO150 Comprehensive Oral Evaluation (new chart made) DO160 Extensive Oral Evaluation-Problem Focused DO180 Comprehensive Periodontal Evaluation DO210 lntraoral Complete Series DO220 lntraoral Periapical, Single Film DO230 lntraoral Periapical, Additional Film DO240 lntraoral Film DO270 Bitewings, Single Film ' D2140 02150 D2160 D2161 D2330 D2331 D2332 D2335 D2390 D2391 D2392 D2393 D2394 D2740 D2750 D2751 D2752 D2790 D2791 D2792 D2799 D2915 D2920 D2930 Amalgam, One Surface (Perm or Primary) Amalgam, Two Surface (Perm or Primary) Amalgam, Three Surface (Perm or Primary) Amalgam, Four+ Surfaces (Perm or Primary) Composite Resin, One Surface, Anterior Composite Resin, Two Surfaces, Anterior Composite Resin, Three Surfaces, Anterior Composite Resin, Four Surfaces or lncisal Composite Resin Crown, Anterior Comp Resin, One Surf., Post., Perm or Prim (includes PRR) Composite Resin, Two Surfaces, Post. (Perm or Primary) Composite Resin, Three Surfaces, Post. (Perm or Primary) Composite Resin, Four Surfaces, Post. (Perm or Primary) Crown-PorcelainlCeramic Substrate Crown-Porcelain Fused To High Noble Metal Crown-Porcelain Fused to Base Metal Crown-Porcelain Fused To Noble Metal Crown- Full Cast High Noble Metal Crown-Full Cast Base Metal Crown-Full Cast Noble Metal Provisional Crown Recement CastIPrefab Post and Core Recement Crowns Crown-Stainless Steel, Primary Tooth D2931 D2932 D2940 D2950 D2951 D2954 D2970 Crown-Stainless Steel, Perm. Tooth Crown-Prefab. Resin, Primary Tooth Sedative Filling Core Buildup, Including Any Pins Pin Retention (Per Tooth) Excludes Restoration Post And Core (Prefab.), Excl Crown Temporary Crown (fractured tooth) ENDODONTICS D3110 Pulp Cap, Direct (Excluding Final Restoration) D3220 Vital Pulpotomy, Primary or Perm. Tooth D3221 Pulpal Debridement, Primary or Perm Tooth D3222 Partial Pulpotomy for Apexogenesis, Perm Tooth D3230 Pulp Therapy, Primary Anterior D3240 Pulp Therapy, Primary Posterior D3310 Endodontic Fill, Anterior D3320 Endodontic Fill, Bicuspid D3330 Endodontic Fill, Molar D3346 Retreat Previous Endo Fill Anterior 03347 Retreat Previous Endo Fill -Bicuspid D3348 Retreat Previous Endo Fill -Molar D3351 ApexificationlRecalcify, Initial Visit D3352 ApexificationlRecalcify, Interim Visit D3353 ApexificationlRecalcify, Final Visit D3410 Apicoectomy/Periradicular Surg., Ant. Tooth D3430 Retrograde Filling, Per Root D3950 Fitting For Preformed Dowel D3960 Bleach Discolored Tooth (Vital or Non-Vital) - PERIODONTICS D4210 Gingivectomy Or Gingivoplasty (4 or more contig. teeth) D4211 Gingivectomy Or Gingivoplasty (1 to 3 teeth) D4240 Gingival Flap Proc. w l Root Planing (4 or more contig. teeth) 04241 Gingival Flap Proc. w l Root Planing (1 to 3 teeth) D4249 Crown Lengthening Proc. Hard Tissue D4260 Osseous Surgery (4 or more contig. teeth) 04261 Osseous Surgery to teeth) ~ 4 2 6 3Bone Replacement Graft, First Site In Quadrant D4274 Distal Prox, Wedge Procedure ( ~ other 1 surg) ~ D4341 Root Planing (4 or more contig, teeth) D4342 Root Planing (1 to 3 teeth) 04355 Full Mouth Debridement (For Perio. Evaluation) D4381 Controlled Release Of Chemo. Agents, Per Site D4910 Periodontal Maintenance After Therapy - Revised Jan 2009
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