Codes and Descriptions for clinical services rendered
Diagnostics
D0120 Periodic Oral Evaluation - Evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health status since a previous comprehensive or periodic evaluation. Also known as the Recall Exam.
D0140 Limited Oral Evaluation - Problem Focused – An evaluation limited to a specific oral health problem or complaint. Also known as the Emergency Exam
D0170.2 Evaluation of Initial Therapy - This is code is entered when patients are appointed to reevaluate quadrant scaling at no charge.
Hygiene-only Screening: An evaluation performed on a family member, friend, or potential NERB patient who will be treated exclusively in the dental hygiene clinics and strictly for dental hygiene needs. The patient is under the care of a private dentist and will be seen by that dentist for all care not included in dental hygiene treatment. This may require interpretation of information acquired through additional diagnostic procedures (i.e. radiographs). The fee will be waived for spouse and children of students and NERB patients by completing a fee-adjustment form these forms can be found in the PCC office.
Though hygienists may collect and interpret the data used for these evaluations, only a dentist can perform the definitive evaluation.
Radiographic/Diagnostic Images
D0120 Intraoral Complete Series, including BW
D0220 Intraoral periapical first image,
D0230 Intraoral periapical each additional image
D0270 bitewing – single
D0272 bitewings- two images
D0274 bitewings- four images
D0330 Panoramic image
Preventive
D1120 Prophylaxis – child Removal plaque, calculus and stain from the tooth structures in the primary and transitional dentition. It is intended to control local irritational factors. Generally applies to a child under 12 yrs. of age.
D1110 Prophylaxis –Adult Removal of plaque, calculus and stain from the tooth structure in the permanent and transitional dentition. Generally applies to patients 12yrs and older.
D1208 Topical Application of Fluoride
D1351 Sealant per Tooth Mechanically and or chemically prepared enamel surface sealed to prevent decay
Periodontal Services
D4341 Periodontal Scaling and Root Planing – four or more teeth per quad this procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature.
D4342 Periodontal Scaling and Root Planing – one to three teeth per quad. See definition above
D4910 Periodontal Maintenance Procedures This procedure is instituted following periodontal therapy and continues at varying intervals, determined by clinical evaluation, for the life of the dentition or implant placement. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.
D4381 Localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth, by report such as Arestin or Periochip