DENTAL CODING STUDY GUIDE

Contents

SL NO. TOPICS
1 INTRODUCTON TO DENTAL CODING

2 DENTAL ANATOMY & TERMINOLOGY

3 DENTAL IMAGING

4 DENTAL EXTRACTIONS

5 CONSERVATIVE DENTISTRY & ENDODONTICS

6 PROSTHODONTIS

7 ORTHODONTICS

8 PEDODONTICS

9 PERIODONTICS

10 ORAL PATHOLOGY

11 COMMUNITY DENTISTRY- PUBLIC HEALTH DENTISTRY

12 ADMINISTRATIVE TERMINOLOGY & BILLING

13 STANDARD ADMINISTRATON – ADA

INTRODUCTION TO CDT, CPT,ICD , MEDICAL CLAIMS VS DENTAL CLAIMS

INTRODUCTION

• A significant area of concern for many International dental practices circles around
dental codes and their ability to accurately code various procedures for insurance
purposes
• Using the correct dental procedure code is critical, and often confusing
• Medical coding relies on Current Procedural Terminology (CPT)
• Medical billing codes for dental procedures utilizes Current Dental Terminology
(CDT)
• The CDT is maintained by the American Dental Association (ADA) contains all the
dental procedure codes required to code each dental procedure(s) for submission to
a specific dental insurance plan.

WHAT ARE CDT CODES?

• Set of medical codes for dental procedures that cover oral health and dentistry
• Each procedural code is an alphanumeric code beginning with the letter “D” (the
procedure code) and followed by four numbers (the nomenclature)
• Includes written descriptions for some of the procedural codes
TYPES OF CDTCODES

CDT Code set is categorized by types of service:

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[Link] Prosthodontics
[Link] Prosthetics
 [Link] Services
[Link] Prosthodontics
[Link] and Maxillofacial Surgery
[Link]
[Link] General Services.

USE OF CPT,CDT AND ICD

Success with dental billing depends to a great extent on having a proper understanding of the
various code sets – CDT, CPT and ICD – and when to use them
Each code set has a different purpose, and each payer has their own rules for claim
submission using these codes
Do dental practices always use CDT Dental Codes?
• Question when to assign CPT codes and when to assign CDT codes. Typically, this is
based on the type of insurance to which the claim will be billed
Providers have three types of coverage options for billing:

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When to use CDT or CPT codes would depend on the

• Type of insurance to which the claim is submitted matters
• Consider type of coverage – dental or medical
• To assign a CDT dental code on the claim for a dental procedure, the patient must
have dental insurance
• Medical plans do not pay for treatment claimed as CDT procedures, dentists need to
report the correct CPT codes to describe the medical treatment when submitting claims
to medical plans
• To bill medical insurance, the dental code intended to be used should have a
compatible medical code
 • identify by cross referencing with the CPT book. Examples of procedures that
have a compatible CPT code are:
• Alveoloplasty w/ extractions per quadrant D7310 / 41874
• I & D of abscess – intraoral soft tissue D7510 / 41800

DENTAL PROCEDURES THAT CAN BE BILLED TO MEDICAL INSURANCE

• All oral and dental procedures associated with any kind of traumatic injury to the
mouth
• Exams and consultations when oral cancer screening is done, and in preparation for
any other medically billable procedure
• Emergency treatment of oral inflammation and oral infections
• Diagnostic, radiographic, and surgical or healing stents
• Radiographs for certain screening and diagnostic purposes
• Biopsies and excisions, including smears and brush biopsies
• Surgery associated with interim and final prostheses necessitated by a traumatic injury
or any medical condition

MEDICAL PLANS WILL PAY FOR:

• Treatment related to inflammation and infection.

• Dental repair of teeth due to injury.
• Exams for orofacial medical problems.
• Extraction of wisdom teeth, under certain conditions.
• Extraction of multiple teeth at one time.
• Certain periodontal surgery procedures.
• Consultation for and excisional biopsy of oral lesions.
 • Consultation and treatment for temporomandibular joint problems.
• Infection that is beyond the tooth apex and not treatable by entry through the tooth.
• Pathology that involves soft or hard tissue.
• Procedures to correct dysfunction.
• Emergency trauma procedures.
• Appliances for mandibular repositioning and/or sleep apnea.
• Congenital defects.

MEDICAL CLAIMS

• The medical claim form is designated as CMS-Form 1500; while dental claim use
J400 form
• ICD-10 codes are required as part of the 1500 medical claim form
• ICD-10 codes are not required as part of the dental claim form, although the ADA
claim form contains a field for placing diagnostic codes
• Most of the patient assume that medical insurance coverage also covers dental
services; the patient must have chosen dental insurance
• Certain dental care is performed according to medica conditions, which could be
billed under medical insurance

Eg; Patient ha ulcer or cyst in gums; Incision and drainage of cyst is done in provider’s
office. The procedure can be billed as either medical or dental
The information required in a dental form are :

1. Area of oral cavity

2. Tooth system
3. Tooth surface
4. Tooth number or letter
5. Procedure description
6. Teeth information that’s missing
MEDICAL NECESSITY IN DENTAL BILLING

• Means dental procedure should be clinically appropriate for the patient’s diagnosed
condition and must be delivered within the recognized and approved standard of care
• Recently dental claims have been denied for payment because of lack of proof of
medical necessity for the procedure.
• Like restorative crowns, sealants and surgical procedures.
• Payers are also looking for the least costly procedure that will satisfy the needs of the
patient’s care
• Medical necessity can be established by
• using the proper and current CDT codes accompanied by documents and supporting
evidence when appropriate such as radiographs, intra-oral photos, periodontal charting,
excellent written narratives and reports from physicians or specialists

ICD 10 CM CODES

• International Classification of Diseases (ICD) is the diagnostic coding system

used with medical claims to describe the condition presented by a patient for
which treatment was rendered
• ICD codes may be used along with CDT codes on claims submitted to dental
benefit plans when needed but are always required on claims for dental services submitted
to medical benefit plans
• ICD-10 code categories K00 to K95 which describe diseases of the digestive
system include diseases of the mouth and conditions treated by dentists

COMMON ICD-10 CODES:

• K08.21-K08.26 – Atrophy
• K08.0 – Exfoliation of Teeth Due to Systemic Causes
 • K05.32 – Chronic Periodontitis, Generalized
• K05.00 – Acute Gingivitis
• K05.10 – Chronic Gingivitis
• K06.01 – Gingival Recession, Localized
• K06.02 – Gingival Recession, Generalized
• • K12.2 – Cellulitis and Abscess of Mouth
• K04.6 – K04.7 – Periapical Abscess
• K00.6 – Disturbances in Tooth Eruption
• K01.1 – Impacted Teeth
• M26.31 – Crowding of Fully Erupted Teeth
• K06.3 – Horizontal Alveolar Bone Loss
• *This is only a partial list

CROSS CODING

• As of October 2018, CDT codes, or D codes, will not be accepted by medical payers
• This means that EVERY procedure code must be submitted with a CPT code

Cross Coding Example

1. D0150 – Comprehensive Oral Evaluation
CPT cross code
• 99202 Level 2 new patient evaluation & management, 20 mins
• 99203 Level 3 new patient evaluation & management, 30 mins
• 99212 Level 2 new patient evaluation & management, 10 mins
• 99213 Level 3 new patient evaluation & management, 15 mins
• D0330 – Panoramic Radiographic Image

D0364, D0365, D0366, D0367, D0368 – Cone beam CT capture

2. CPT Cross Code
• 70486 Computed tomography, maxillofacial area; without contrast material
MODIFIER AND QUALIFIERS

• Add additional information about a procedure, CPT or HCPCS

• Up to 4 modifiers per procedure can be used
• No limit on the number of qualifiers per procedure code

Common Modifiers
• 25 – Separate E&M Service on Same Day of a Procedure
• 26 – Professional Component
• TC – Technical Component
• 50 – Bilateral Procedure
• 51 – Multiple Procedures
• 52 – Reduce Services

Common Modifiers
JP – Universal/National Tooth Designation System
00 – Entire Oral Cavity
01 – Maxillary Arch
02 – Mandibular Arch
10 – Upper Right Quadrant
20 – Upper Left Quadrant
30 – Lower Left Quadrant
40 – Lower Right Quadrant
*This is only a partial list
COMMON DENTAL CLAIM DENIALS

Claim denials can hurt both Dental Insurance Billing Company and patients
Common Causes for Claim Denial
• The Treatment Procedure Is Uncovered
• Error in Entering Patient’s Information
• Claim Denied for No Pre Authorization
• 80% of claims get denied with no authorization being obtained
• There are some dental treatments that may require prior authorization.
• Should get prior authorization for complex dental treatments like surgeries.

• Claim Denied Due to Issues in COB

• COB or Coordination of Benefits is a term used when patients have two or more
health insurance plans. There are certain rules that decide which dental insurance plan
pays primary, secondary or tertiary. Providers need to ask patients whether they have
primary, secondary or any other carrier
• Claim Not Filed on Time
• Incorrect or missing Billing Codes
• Credentialing
• Dental practitioners need to be credentialed with insurance providers
DENTAL ANATOMY AND TERMINOLOGIES

WHAT IS DENTISTRY?

BRANCH OF MEDICINE CONSISTS :

• DIAGNOSIS

• TREATMENT

• PREVENTION

• CONDITIONS,DISORDERS AND DISEASES OF TEETH,GUMS,MOUTH AND

JAW

BRANCHES OF DENTISTRY- 9 SPECIALITIES

• ORAL MEDICINE AND RADIOLOGY

• Diagnosis and X-RAYS

• ORAL &MAXILLOFACIAL SURGERY

• Minor and Major Surgeries

• PERIODONTICS

• Prevention, diagnosis, and treatment of periodontal, or disease, and in the placement

of dental implants

• PEDODONTICS

• Deals with the care of children's teeth

• CONSERVETIVE &ENDODONTICS

• Direct and indirect restorations of individual teeth in the mouth

• PROSTHODONTICS & IMPLANTOLOGY :

• Restoring missing tooth and jaw structures
 • ORAL PATHOLOGY :
• The causes of diseases that alter or affect the oral structures as well as
parts of the face and neck
• ORTHODONTICS :
Diagnosis, prevention and correction of malpositioned teeth and jaws
• PUBLIC HEALTH DENTISTRY (COMMUNITY DENTISTRY) :
• Population-based dentistry, oral health surveillance, policy
development, community-based disease prevention and health promotion,
and the maintenance of the dental safety

4 Main Dental Tissues

• Enamel

• Dentin

• Cementum

• Dental Pulp

PARTS OF TOOTH

• Anatomic crown

• Neck

• Root

TOOTH- CROWN & ROOT CROWN

• Tooth enamel is the visible, outermost covering of your teeth.

• Dentin or dentine is a layer of material that lies immediately underneath the enamel of
the tooth

• The pulp is the part in the center of a tooth made up of living connective tissue and
cells called odontoblasts
TYPES OF TEETH

• Incisors
• Canines
• Premolars
• Molars

TYPES OF DENTITION

PRIMARY TEETH

(DECIDUOUS TEETH/MILK TEETH)

PERMANENT TEETH

PRIMARY TEETH

• Consist of 20 teeth

• Begin to form during the first trimester of pregnancy

• Typically begin erupting around 6 months

• Most children have a complete primary dentition by 3 years

of age

PERMANENT TEETH

• Consist of 32 teeth in most cases

• Begin to erupt around 6 years

of age

• Most permanent teeth have erupted by age 12

• Third molars (wisdom teeth) are the exception; often do not appear until late teens or
early 20s
CLASSIFICATION OF TEETH

ANTERIOR TEETH

• INCISORS

• CANINES

POSTERIOR TEETH

• PREMOLARS

• MOLARS

CLASSIFICATION OF TEETH

• Incisors (central and lateral)

• Canines (cuspids)

• Premolars (bicuspids)

• Molars

FUNCTIONS OF TEETH

• INCISORS( Central/lateral) - Cutting instrument of food

• CANINES - Longest root of all tooth , Location- corner of dental arch. Tearing of
food Crucial role in orthodontics

• PREMOLARS - Tearing and Grinding

• Molars - Grinding
QUADRANTS OF THE MOUTH
SKULL

JAWBONE- THE FRAMEWORK OF THE MOUTH

• UPPER JAW - MAXILLA

• LOWER JAW - MANDIBLE

• JOINT - TEMPROMANDIBULAR JOINT

TWO JOINTS CONNECTING THE JAWBONE TO THE SKULL

FUNCTIONS : MOVEMENTS

• PROTRUSION AND RETRACTION - THE UPPER PART OF THE JOINT

ALLOWS – THE ANTERIOR AND POSTERIOR MOVEMENTS OF THE JAW

• ELEVATION AND DEPRESSION - THE LOWER PART OF THE JOINT

PERMITS ELEVATION AND DEPRESSION OF THE MANDIBLE; OPENING
AND CLOSING THE MOUTH

DENTAL TERMINOLOGIES

• ABSCESS - COLLECTION OF PUS.

• ACUTE/CHRONIC PERIAPICAL ABSCESS

• ACUTE/CHRONIC INFLAMATION OF PULP.{ END OF THE ROOT}

• ACUTE/CHRONIC PERIRADICULAR ABSCESS

• ACUTE / CHRONIC INFLAMATION OF PULP.{AROUND A TOOTH ROOT}

• PERIDONTAL ABSCESS-ABSCESS OF GINGIVA OR PERIDONTAL

STRUCTURES
• Abutment: a tooth or implant used to support a prosthesis

• implant case – the fixture that is placed between the implant body and the restorative
prosthesis (e.g., single crown; denture).

• natural tooth case – the tooth used as the support for one end of a denture.

• Abutment crown: Artificial crown also serving for the retention or support of a
dental prosthesis

• Acid etching: Use of an acidic chemical substance to prepare the tooth enamel and or
dentin surface to provide retention for bonding
• Adhesion: two surfaces are held together by chemical or physical forces or both with
or without the aid of an adhesive
• Adjunctive: A secondary treatment in addition to the primary therapy
• Allogenic : same species, but genetically different
• Alloy: Compound combining two or more elements
• Evulsion /Avulsion: Separation of the tooth from its socket due to trauma
• Amalgam : tooth filling material(mercury +tin ,silver , copper etc)

• Anomaly : Abnormality

• Apex: The tip or end of the root end of the tooth

• Apexification: The treatment for necrotic teeth with open apex

• Apexogenesis : Vital pulp therapy performed to encourage continued
physiological formation and development of the tooth root
• Apicoectomy : Amputation of the apex of a tooth

• Alveolar: The bone to which a tooth is attached

• Alveoloplasty: Surgical procedure for recontouring supporting bone, sometimes in

preparation for a prosthesis

• Anterior: Mandibular and maxillary centrals, laterals and cuspids

• Bruxism : The Para functional grinding of the teeth

• Bicuspid: A premolar tooth; a tooth with two cusps

• Bleaching: Process of lightening of the teeth

• Bonding: Process by which two or more components are made integral by mechanical
and/or chemical adhesion at their interface

• Bridge: Fill the gap created by one or more missing teeth ,Abutments +Pontic +
Crown eg: 3 unit bridge

• Calculus : HARD DEPOSITS –CROWN /ROOT

• Canal: A relatively narrow tubular passage or channel. EG .ROOT

CANAL,MANDIBULAR CANAL

• Bruxism : The Para functional grinding of the teeth

• Bicuspid: A premolar tooth; a tooth with two cusps

• Bleaching: Process of lightening of the teeth

• Bonding: Process by which two or more components are made integral by mechanical
and/or chemical adhesion at their interface

• Bridge: Fill the gap created by one or more missing teeth ,Abutments +Pontic +
Crown eg: 3 unit bridge

• Calculus : HARD DEPOSITS –CROWN /ROOT

• Canal: A relatively narrow tubular passage or channel. EG .ROOT

CANAL,MANDIBULAR CANAL

• Bruxism : The Para functional grinding of the teeth

• Bicuspid: A premolar tooth; a tooth with two cusps

• Bleaching: Process of lightening of the teeth

• Bonding: Process by which two or more components are made integral by mechanical
and/or chemical adhesion at their interface

• Bridge: Fill the gap created by one or more missing teeth ,Abutments +Pontic +
Crown eg: 3 unit bridge

• Calculus : HARD DEPOSITS –CROWN /ROOT

• Canal: A relatively narrow tubular passage or channel. EG .ROOT

CANAL,MANDIBULAR CANAL
• Cephalometric image : study of the measurements of the head

• Cleft palate: Congenital deformity resulting in lack of fusion of the soft and/or hard
palate, either partial or complete

• Cleft lip :(congenital deformity- lip)

• Contiguous: Adjacent; touching.

• Cusp: Pointed or rounded eminence

• Debridement: Removal of subgingival and/or supragingival plaque and calculus

• Dentition: The teeth in the dental arch

• Adolescent dentition– permanent dentition prior to cessation of skeletal growth

• Primary deciduous (dentition)– primary teeth in the dental arch.

• Permanent dentition (adult dentition) – permanent teeth in the dental arch

• Transitional dentition– mixed dentition; begins with the appearance of the permanent
first molars and ends with the exfoliation of the deciduous teeth

• Debridement: Removal of subgingival and/or supragingival plaque and calculus

• Dentition: The teeth in the dental arch

• Adolescent dentition– permanent dentition prior to cessation of skeletal growth

• Primary deciduous (dentition)– primary teeth in the dental arch.

• Permanent dentition (adult dentition) – permanent teeth in the dental arch

• Transitional dentition– mixed dentition; begins with the appearance of the permanent
first molars and ends with the exfoliation of the deciduous teeth

• Denture: Artificial tooth

[Link] denture,

2 partial denture(fixed/removable]

3. immediate denture: Prosthesis constructed for placement immediately after removal

of remaining natural teeth
• Diastema : Space between two adjacent teeth

• Dry socket: Localized inflammation of the tooth socket following extraction due to
infection or loss of blood clot; osteitis

• Dental prophylaxis/SCALING: A cleaning procedure performed to thoroughly clean

the teeth. Prophylaxis is an important dental treatment for halting the progression of
periodontal disease and gingivitis

• [Link] denture,

• 2 partial denture(fixed/removable]

• 3. immediate denture: Prosthesis constructed for placement immediately after removal

of remaining natural teeth

• Diastema : Space between two adjacent teeth

• Dry socket: Localized inflammation of the tooth socket following extraction due to
infection or loss of blood clot; osteitis

• Dental prophylaxis/SCALING: A cleaning procedure performed to thoroughly clean

the teeth. Prophylaxis is an important dental treatment for halting the progression of
periodontal disease and gingivitis

• [Link] denture,

• 2 partial denture(fixed/removable]

• 3. immediate denture: Prosthesis constructed for placement immediately after removal

of remaining natural teeth

• Diastema : Space between two adjacent teeth

• Dry socket: Localized inflammation of the tooth socket following extraction due to
infection or loss of blood clot; osteitis

• Dental prophylaxis/SCALING: A cleaning procedure performed to thoroughly clean

the teeth. Prophylaxis is an important dental treatment for halting the progression of
periodontal disease and gingivitis
• Direct pulp cap: Procedure in which the exposed vital pulp is treated with a
therapeutic material

• Discectomy: Excision of the intra-articular disc of a joint

• Displaced tooth: A partial evulsion of a tooth

• Edentulous: Without teeth

• Extraction: The process or act of removing a tooth or tooth parts

• Exostosis (Osteoma) : Overgrowth of bone

• Excision: Surgical removal of bone or tissue

• Exclusions: Dental services not covered under a dental benefit program

• Exfoliative: a thin layer of epidermis shed from the surface.

• Extraoral: Outside the oral cavity

• Extracoronal: Outside the crown of a tooth

• Exudate: A material usually resulting from inflammation or necrosis that contains

fluid, cells, and/or other debris

• Facial: The surface of a tooth directed toward . the cheeks or lips (i.e., the buccal and
labial surfaces) and opposite the lingual surface

• Foramen: Natural opening into or through bone

• Frenum: Muscle fibers covered by a mucous membrane that attaches the cheek, lips
and or tongue to associated dental mucosa

• Furcation: The anatomic area of a multirooted tooth where the roots diverge

• Filling: A lay term used for the restoring of lost tooth structure by using materials
such as metal, alloy, plastic or porcelain

• Gingiva: Soft tissues overlying the crowns of unerupted teeth and encircling the
necks of those that have erupted

• Gingivectomy: The excision or removal of gingiva

• Gingivitis: Inflammation of gingival tissue without loss of connective tissue.

• Gingivoplasty: Surgical procedure to reshape gingiva.

• Hemisection: Surgical separation of a multi-rooted tooth.

• Histopathology: The study of disease processes at the cellular level.

• Homologous: Similar in structure.

• Hyperplastic: an abnormal increase in the number of cells in an organ or a tissue

with consequent enlargement.

• Gingiva: Soft tissues overlying the crowns of unerupted teeth and encircling the necks
of those that have erupted

• Gingivectomy: The excision or removal of gingiva

• Impacted tooth: An unerupted or partially erupted tooth.

• Implant: Material inserted or grafted into tissue.

• Inlay : fixed dental restoration made outside of a tooth.

• Interim: Temporary.

• Intraoral: Inside the mouth.

• Indigent: Those individuals whose income falls below the poverty line as defined by
the federal Office of Management and Budget (OMB).

• interproximal: Between the adjoining surfaces of adjacent teeth in the same arch.

• intracoronal: "within" the crown of a tooth.

• Intentional reimplantation: The intentional removal, radicular repair and replacement

of a tooth into its alveolus
• Keratin: A protein present in all cuticular structures of the body, such as
hair, epidermis and horns

• Line angle: The junction of two surfaces of a tooth, or of two walls of a tooth
cavity preparation

• Point angle : Junction of three surfaces

• Locus: A site or location

• Malar/zygomatic bone: Cheek bone

• Moulage: A positive reproduction of a body part formed on a cast from a negative
impression
• Mucous membrane: Lining of the oral cavity as well as other canals and cavities of
the body; also called "mucosa."
• Mouthguard: Individually molded device, design to prevent injury to the teeth and
their surrounding tissues. Sometimes called a mouth protector.
• Types of mouth guard – stock, boil and bite, custom
• Malocclusion: Improper alignment of upper and lower teeth.
• Microabrasion: Mechanical removal of a small amount of tooth structure to eliminate
superficial enamel discoloration defects.
• Obturate: the sealing of the canal(s) of roots during RCT, Procedure - Obturation
• Obturator: A disc or plate which closes an opening; a prosthesis that closes an
opening in the palate.(CLEFT PALATE)
• Onlay : A dental restoration made outside the oral cavity that covers one or more
cusp tips and adjoining occlusal surfaces
• Odontogenic: Refers to tooth-forming tissues
• Operculum: The flap of tissue over an unerupted or partially erupted tooth
• Operculectomy: Removal of the operculum
• Orthognathic: Functional relationship of maxilla and mandible
• Osteoplasty: Surgical procedure that modifies the configuration of bone
• Osteotomy: Surgical cutting of bone
• Overdenture: A removable prosthetic device that overlies and may be supported by
retained tooth roots or implants
• Occlusion: Any contact between biting or chewing surfaces of maxillary (upper) and
mandibular (lower) teeth
• Orthotics / orthosis :Are made of clear acrylic, molded to fit your lower teeth
• Palate: The hard and soft tissues forming the roof of the mouth that separates the oral
and nasal cavities
• Palliative: Action that relieves pain but is not curative
• Parafunctional: Other than normal function or use
• Pin: A small rod, cemented or driven into dentin to aid in retention of a restoration
• Plaque : soft sticky substance – teeth- bacteria and bacterial derivatives
• Pericoronal: Around the crown of a tooth
• periodontal pocket: Pathologically deepened gingival sulcus
• Pontic: The term used for an artificial tooth on a fixed partial denture (bridge)
• Periodontitis: Inflammation and loss of the connective tissue of the supporting or
surrounding structure of teeth with loss of attachment
• Periodontium: tissue complex comprising gingival, cementum, periodontal ligament,
and alveolar bone which attaches, nourishes and supports the tooth
• Post: Rod-like component - prepared root canal space to provide structural support
• Prosthesis: Artificial replacement of any part of the body
• Radicular: root
• Retainer: to stabilize
• Residual root: Remaining root structure following the loss of the major portion (over
75%) of the crown
• Root planing: A treatment procedure designed to remove cementum or surface dentin
that is rough, impregnated by calculus, or contaminated with toxins or
microorganisms
• Rebase: Process of refitting a denture by replacing the base material
• Reline: Process of resurfacing the tissue side of a removable prosthesis with new base
material
• Retrograde filling: A method of sealing the root canal by preparing and filling it from
the root apex
• Rubber dam: A barrier technique used to prevent the passage of saliva or moisture, or
to provide an isolated operative field
• Sealant: material - the occlusal surfaces - posterior teeth - prevent occlusal caries
• Sialography: Inspection of the salivary ducts and glands by radiograph after the
injection of a radiopaque medium
• Sialolithotomy: Surgical procedure by which a stone within a salivary gland or its
duct is removed, either intraorally or extraorally
• Sialodochoplasty: Surgical procedure for the repair of a defect and/or restoration of
portion of a salivary gland duct
• Space maintainer: A passive appliance, usually cemented in place, that holds teeth in
position
• Splint: device used to support, protect, or immobilize-loosened, replanted, fractured
• Stomatitis: Inflammation of the membranes of the mouth.
• Supernumerary teeth: Extra erupted or unerupted teeth that resemble teeth of normal
shape.
• Succedaneous tooth: A permanent tooth that replaces a primary (deciduous) tooth.
• Torus: A bony elevation or protuberance of bone
• Trismus: Restricted ability to open the mouth, usually due to inflammation or fibrosis
of the muscles of mastication.
• Transplantation: Surgical placement of biological material from one site to another.
• Transplantation of tooth: Transfer of a tooth from one socket to another, either in the
same or a different person.
• Tuberosity: A protuberance on a bone
• Unerupted: Tooth/teeth that have not penetrated into the oral cavity
• Unilateral: One-sided; pertaining to or affecting but one side
• Vestubule : a passage, hall, or room between the outer door and the interior
• Vestibuloplasty: Any surgical procedures designed to increase relative alveolar ridge
height
• Wax pattern: A wax form that is the positive likeness of an object to be fabricated.
• Xerostomia: Decreased salivary secretion
ANESTHESIA

Controls the patient's level of anxiety or pain.

• Analgesia: the diminution or elimination of pain

• Anxiolysis: the diminution or elimination of anxiety.

• General anesthesia

• Local anesthesia

• Deep sedation

• Minimal sedation

• Moderate sedation

• Inhalation

• Intravenous

• Non-intravenous

• Regional block anesthesia

• Trigeminal division block anesthesia

RADIOGRAPHS

• Bitewing: cavities between teeth

• Occlusal: This X-ray is done when your jaw is closed to see how your upper and
bottom teeth line up
• Panoramic: For this type of X-ray, the machine rotates around the head.
 • Periapical: This technique focuses on two complete teeth from root to crown.
• Panoramic radiograph: An extraoral projection whereby the entire mandible, maxilla,
teeth, and other nearby structures are portrayed on a single image, as if the jaws were
flattened out.
• Tomography: An X-ray technique that produces an image representing a detailed
cross section of tissue structures at a predetermined depth.

DENTAL DIAGNOSTIC IMAGING

RADIOGRAPHS

RADIOGRAPH-
 Record of an image produce by transmission of x-ray through an object
 RADIOLOGY-
 Interpretation of radiographic images

DENTAL RADIOGRAPHS
 Dental x-rays (radiographs) are images of the teeth uses to evaluate the oral health
 Low levels of radiation to capture images of the interior of the teeth and gums
 Helps dentist to identify problems, like cavities, tooth decay, and impacted teeth

Types of Intra oral X-rays

Periapical
 This technique focuses on two complete teeth from root to crown

Panoramic

For this type of X-ray, the machine rotates around the head.

The dentist may use this technique :

 To check your wisdom teeth
 Plan for implanted dental devices
 Or investigate jaw problems

TYPES OF EXTRA ORAL X-RAYS

Tomograms

Show a particular layer or "slice" of the mouth while blurring out all other
layers
 This type of x-ray is useful for examining structures that are difficult to clearly see
 For instance, because other structures are in very close proximity to the structure
to be viewed
Cephalometric projections
 Show the entire side of the head
 This type of X-ray is useful for examining the teeth in relation to the jaw and
profile of the individual
 Orthodontists use this type of X-ray to develop their treatment plans

Computed Tomography (CT scanning)

Magnetic Resonance Imaging

Ultra sound in Dentistry

Sialendoscopy

Minimally invasive technique that is employed as a diagnostic and therapeutic aid

in various non-neoplastic salivary gland disorders such as sialolithiasis, sailadenitis
and other obstructive pathologies
DENTAL DIAGNOSTIC IMAGING CODES

Dental Radiographs

Dental Radiographs and other imaging modalities are used to

 diagnose and monitor oral diseases
 to monitor dentofacial development and the progress or prognosis of therapy

Practice can bill dental or medical insurance for the Radiology Report

RECOMMENDATIONS FOR PRESCRIBING DENTAL RADIOGRAPHS

• The recommendations are subject to clinical judgment and may not apply
to every patient
• To be used by dentists only after reviewing the patient’s health history
and completing a clinical examination
• Even though radiation exposure from dental radiographs is low, once a
decision to obtain radiographs is made it is the dentist's responsibility to
follow the ALARA Principle (As Low as Reasonably Achievable) to
minimize the patient's exposure.

CDT Codes (D0364 – D0368) – CONE BEAM Computed tomography

 CBCT should not replace traditional dental radiographs as a preliminary
diagnostic tool, or for routine dental procedures such as restorations
 Used as an adjunct when the level of detail CBCT is needed to safely render
treatment for complex clinical conditions
 oral surgery, implant placement and endodontics (procedures may have a higher
risk of complications without the level of detail CBCT imaging provides)
 CBCT imaging used for these reasons should be read and interpreted by an
appropriately trained professional
 It is the imaging procedure and not the radiographs that determine the CDT
 selection
 D0364 to D0368 are classified based on
 Capture and interpretation
 Views (limited one, one full dental arch – anatomical sites,TMJ)
 D0380 – D0386
 Image capture ONLY ; Interpretation and report performed by a practitioner NOT
associated with the capture
 Views ( limited one, one full dental arch – anatomical sites,TMJ)
 Assign D 0391 – If documentation supports iinterpretation and report performed
by a practitioner NOT associated with the capture

Separate image capture from interpretation

Some Dental practices cannot affort to have CT scans. So doctors

choose outside imaging centers

For the Radiology Report:

CDT/Dental: D0391 ("Interpretation of diagnostic image by a practitioner not associated
with capture of the image, including report.")
CPT/Medical: 76140 ("Consultation on x-ray examination made elsewhere, written report.")
 For the Image Portfolio:
ADA/Dental: D0363 ("Three-dimensional image reconstruction using existing data,
includes multiple images.")

Bitewings and extraoral images – CDT PERSPECTIVE

 A bitewing radiograph is the image captured after the procedure is performed
 DOES NOT refer to the armamentarium used to produce the image
 Bitewing image can be of a single tooth or multiple teeth depending on the
condition

Note : Bitewing image does not limit the image to a specific size as per definition.
The given image is taken in size 2 films which is not same a bitewing

Sample claim form

Encounter with following procedures

• Image capture only (4 bitewings)

• Interpretation only (4 images)

• Asynchronous Teledentistry
 Box 29 b is the quantity area used to represent the number of images for each
code.
If more than one type of image capture on a date of service , the report the CDT
and quantity .
This is a per image procedure so each image interpretation is billed in quantity

D0210
➢ Covered based on the last service date once every three (3) years,
➢ The exception of the Federal plan -which is covered once every five (5)
years, based on the last service date.

D0220
➢ 1 per day (no waiting period)

D0230
➢ Not to exceed five (5) films per date of service. (No waiting period)

CODES-Bitewings

D0270

D0272

D0273 One (1) set per calendar year

D0274

NOTE:

❖ Any of these codes constitute a set of bitewings.

❖ When bitewings are taken within 12 months of a Full mouth radiographic

examination(FMX), these guidelines apply.
 D0277

➢ If bitewings have been taken prior to a FMX, no limitation applies and both
procedures will be paid.

➢ If bitewings are submitted within 12 months after a FMX has been paid, then the
bitewings are denied due to the 1 in 12 month limitation for bitewings.

➢ The member will be responsible for the cost of the bitewings.

 D0330
Panoramic film is allowable in place of a complete series (D0210) based on the last service
date, with the frequency depending upon the terms of the dental plan. Allowance for a
complete series varies among dental plans and ranges from one (1) per calendar year to one
(1) every five (5) years.

➢ Additional panoramic film may be allowed for oral surgeons, provided any previous
panoramic film is more than twelve (12) months old.

DOCUMENTATION OF PROCEDURES
 Where image capture and interpretation were parsed, as follows –

❖ Image capture only –

capture by practitioner not associated with interpretation and report”

❖ Interpretation and report only –

interpretation and report by a practitioner not associated with image capture

❖ Post processing of image or image sets– for separate manipulations of digital

imaging data
CPT CODES FOR DENTAL IMAGING

70486

Cone beam CT image capture with limited field of view – less than one whole jaw

cone beam CT image capture with field of view of one full dental arch – mandible

maxillofacial MRI image capture ;maxillofacial ultrasound image capture

70355

Panoramic radiographic image – image capture only

70350

2-D cephalometric radiographic image

DENTAL EXTRACTIONS

DENTITION

PRIMARY DENTITION

20 TEETH

UPPER 10 AND LOWER 10

PERMANENT DENTITION

32 TEETH(UPPER 16 AND LOWER 16)

EXTRACTION OF TOOTH
(Exodontia)

 COMPLETE REMOVAL OF ONE OR MORE TEETH FROM THE MOUTH

INDICATIONS OF TOOTH EXTRACTION

 Teeth affected by decay or periodontal disease to the extent that they cannot be treated
with a dental filling, crown or root canal treatment
 Injury or trauma that has led to a broken or damaged tooth that is beyond repair
 A dental or gum abscess that has weakened the root of the tooth
 Malocclusion or crowding of teeth
 Impaction of teeth (most commonly of the wisdom teeth) that has led to
failure of the tooth to emerge from the gum

 Severe Abrasion : Mechanical wearing of tooth

 Teeth causing chronic trauma or irritation to soft tissues
Teeth Interfering With The Stability And Fitness Of Restoration
Before Radiation Therapy In Cancer Patient
Teeth Involve In The Fracture Line Of Jaw
Traumatic Avulsion Due To Fracture Of Alveolar Bone
Grossly Decayed Crown
Severe crowding in the dental arch can limit access to the application of
a forcep

Teeth with unusual root morphology.

TYPES OF EXTRACTION

SIMPLE EXTRACTION
 The dentist loosens the tooth with an instrument called an elevator. Then the
dentist uses an instrument called forceps to remove the tooth

 It is used for the teeth that are visible and easily accessible. Dentists use local
anesthesia for the procedure.

PRIMARY TEETH(MILK TEETH)EXTRACTION

 Tooth resorption is the progressive loss of dentine and cementum by the action of
osteoclasts
 When permanent teeth starts to errupt,it resorps the roots of existing primary
tooth
 After complete resorption -only coronal remnants(crown portion) is remaining
 Extraction of coronary remnants is a simple procedure

SURGICAL EXTRACTION(TRANS ALVEOLAR EXTRACTION)

Surgical dental extraction involves the removal of teeth that are not easily
accessible inside the mouth.

This may be because they have not erupted through the gum completely or
they have been fractured under the gum line

In this case, it is necessary to make an incision into the connective tissue
surrounding the tooth to gain access to it for extraction.

For example, the soft tissues that cover the tooth may be elevated, or a drill or
osteotome may be needed to remove some of the nearby jawbone during the
extraction procedure
SECTIONING OF TEETH

 In many cases of surgical dental extraction, the tooth may need to be fragmented
into several pieces to allow it be removed

IMPACTED TEETH

Impacted Tooth: An unerupted or partially erupted tooth that is positioned against

another tooth, bone, or soft tissue so that complete eruption is unlikely.

Partially Bony Impaction: Part of tooth crown covered by bone; requires

mucoperiosteal flap elevation and bone removal

Soft Tissue Impaction: Occlusal surface of tooth covered by soft tissue; requires
mucoperiosteal flap elevatio

Coronectomy: Intentional partial tooth removal performed when a neurovascular

complication is likely if the entire Impacted Tooth is removed

Completely Bony Impaction with Unusual Surgical Complications: Most or all of a

crown covered by bone; usually difficult or complicated due to factors such as
nerve dissection required, separate closure of maxillary sinus required

SYMPTOMS OF IMPACTED TEETH

• Red, swollen, or bleeding gums
• Bad breath
• A bad taste in your mouth
• Difficulty opening your mouth
• Pain when opening your mouth, or when chewing and biting
• Symptoms may come and go over weeks or months
 FACTORS THAT COMPLICATE THE EXTRACTION PROCEDURE

 Crown
 Roots
 Bone
 Diminished access
 Adjacent/non-adjacent teeth
 Adjacent vital structures
 Prosthetic concerns

ALVEOLOPLASTY

• An alveoloplasty is a surgical procedure that reshapes and smooths out

the jaw where a tooth or teeth have been extracted or lost.

• The part of the jawbone that houses the teeth is called the alveolus, and
"plasty" means molding, so alveoloplasty is the process of molding or
reshaping the jaw.

TYPES OF ALVEOLOPLASTY
ALVEOLOPLASTY WITH EXTRACTION(SIMPLE ALVEOLOPLASTY)

 Alveoloplasty, in conjunction with extractions, is a surgical procedure that

recontours the alveolar bone and is usually performed to prepare the alveolar ridge
for a dental prosthesis or other treatments such as radiation therapy and
transplant surgery
  POST SURGICAL ALVEOLOPLASTY(POST EXTRACTION
ALVEOLOPLASTY)

 Done in regions where extraction is done at different [Link] in this cases

multiple areas will show sharp edges which are painful to touch.

 Here crestal incision is taken and mucoperiosteal flap is elevated for

trimming the sharp edges ans subsequent suturing is done.

DENTAL EXTRACTION CODING

CDT CODE SELECTION

• Selection of CDT Codes depends on the clinical scenario

• CDT Codes, published in the current CDT manual, are used to document
the different extraction procedures.

EXTRACTIONS CODES INCLUDE

[Link] anesthesia

[Link] if needed

[Link] post operative care

CDT CODES - Erupted Tooth Vs crown Vs root extraction
• D7140
• Reported when a dentist completes the erupted tooth extraction procedure and the
crown and root are extracted in one piece.
• The descriptor of this code includes routine removal of tooth structure, minor
smoothing of socket bone and closure as necessary

• D7210
• Reported when the crown and root separated during the extraction procedure (for any
reason) and both were removed, with the removal of the root tip requiring bone removal.
• Including elevation of mucoperiosteal flap if indicated. Once per tooth
• The descriptor for this code

Removal of residual tooth

 D7250
➢ Reported when removal of residual tooth roots Includes cutting of soft tissue and
bone, removal of tooth structure, and closure
 D7111
➢ Report when coronal remnants of primary tooth remov

Alveoloplasty

• D7310
Alveoloplasty in conjunction with extractions – four or more teeth or tooth spaces, per
quadrant is used
When bone recontouring is performed involving four or more teeth or tooth spaces

• D7311
Alveoloplasty in conjunction with extractions – one to three teeth or tooth spaces, per
quadrant
NOTE
• The two codes are used when the alveoloplasty is a distinct surgical procedure from
extraction and/or surgical extractions.

• As such, these codes may be reported in addition to the extraction codes when
supported by documentation.

• Two codes describe the anatomical area of bone encompassed in the alveoloplasty.
When the area is less than four teeth or tooth areas, the code for one to three teeth or tooth
spaces is used.

REMEMBER
• An alveoloplasty is performed only when there is need for significant bone
recontouring in the area of the extraction and not just the lesser procedure of smoothing
the socket bone.

• The smoothing of the socket site includes facial and septal alveolar bone.

CDT- CODES – Bone grafts, GTR Membranes

• (D4263, D4264, D4265)
Bone grafts

• (D4266, D4267)
GTR membranes (GUIDED TISSUE REGENERATION )

• NOTE:
• Are not covered in conjunction with oral surgery codes (D7000-D7999).

REMOVAL OF IMPACTED TOOTH

• Procedures include:

• Local anesthesia

• Suturing if needed

• Routine postoperative care.

• D7241 is a “by report” procedure and will be reviewed by the dental consultant, once
per tooth
REMOVAL OF IMPACTED TOOTH

✓ D7220

✓ D7230

✓ D7240

✓ D7241

Residual tooth removal

• Procedures include
• local anesthesia,
• suturing if needed,
• routine post-operative care.
• Extraction of a tooth and surgical removal of a residual root of the same tooth, on the
same service date are not paid separately.

Residual tooth
 D7250
➢ Surgical removal of residual tooth roots (cutting procedure)
CONSERVATIVE & ENDODONTICS

The world emphasis is on prevention and conservation, these two specialties play very
vital role in saving the teeth
It is the branch of dentistry, Conservative dentistry deals with treatment of
• Caries
• Malformed
• Discoloured
• Non-esthetic
• Fractured teeth
Endodontics deals with
• Treatment of pulpal and peri-apical diseases and dental pain management.

TREATMENTS PERFORMED IN THE DEPARTMENT ARE:

Amalgam restorations

Composite restorations

GIC restorations

Pulp capping procedures

Root canal treatment

Apexification

Post & Core

Bleaching

Aesthetic dental procedure

Minor surgical procedure such as hemisection, Radisection

Surgical procedures ( eg ;Apicoectomy)

Regenerative endodontic procedure

LAB PROCEDURES PERFORMED IN THE DEPARTMENT

Inlay & Onlay fabrication

Cast post & core

Metallic & Ceramic crown preparations

TREATMENT OF CAVITIES :

Depends on how severe the cavities [Link] options include:

Fluoride Treatments
• If your cavity just started, a fluoride treatment may help restore your
tooth's enamel and can sometimes reverse a cavity in the very early stages.
Fillings
• Fillings, also called restorations, are the main treatment option when decay
has progressed beyond the earliest stage.
• Fillings are made of various materials, such as tooth-colored composite
resins, porcelain or dental amalgam that is a combination of several materials.

AMALGAM FILLING

• Dental amalgam is a liquid mercury and metal alloy mixture used

in dentistry to fill cavities caused by tooth decay.
COMPOSITE FILLING

• Dental composite resins ( "resin-based composites" or simply "filled resins")

are dental cements made of synthetic resins synthetic resins evolved
as restorative materials
• Insoluble,
• Good tooth-like appearance,
• Insensitive to dehydration,
• Easy to manipulate
• Reasonably inexpensive

DENTAL CURING LIGHT

• A dental curing light is a piece of dental equipment that is used

for polymerization of light cure resin- based composites It can be used on several
different dental materials that are curable by light.

• The light used falls under the visible blue light spectrum.

• This light is delivered over a range of wavelengths and varies for each type of
device.

• There are four basic types of dental curing light sources:

• tungsten halogen ,light-emitting diodes(LED), plasma arcs ,and lasers

• The two most common are halogen and LEDs.

GIC- GLASS IONOMER CEMENT

A glass ionomer cement (GIC) is a dental restorative material used in dentistry as

• Filling material
 • Luting cement including for orthodontic bracket attachment.
• Glass-Ionomer cements are based on the reaction of silicate glass-powder
(calcium alumino- fluorosilicate glass) and polyacrylic acid an ionomer

TYPES OF GIC

CONSERVATIVE AESTHETIC PROCEDURE

Significant improvements in tooth-colored restorative materials and adhesive techniques

have resulted in numerous conservative esthetic treatment possibilities
• A simple treatment consisted of removing part of the discolored enamel, acid
etching the preparations, and restoring with direct-composite partial veneers
 • Teeth Whitening
Teeth whitening can be one of the simplest and least expensive ways to improve
your smile. Teeth can be bleached with in-office products in your dentist’s office

• Dental Veneers
• Dental veneers are wafer-thin, custom-made shells of tooth-colored porcelain
or resin that cover the front surface of the teeth.
• After removing about a half-millimeter of enamel from the tooth surface, these
thin shells are bonded (cemented) to the front of the teeth, changing their color,
shape, size, or length.
• Veneers are often called “hollywood teeth.

Dental crown

Dental crown, also called a cap, fits over and replaces the entire decayed or
damaged tooth above the gum line, restoring its shape, size, strength,
and appearance.
• Crowns keep a weak tooth from breaking or hold a cracked tooth together;
they can be used cosmetically to cover misshapen or severely discolored teeth.
• Crowns can be made from metal, porcelain-fused-to-metal, resin, or ceramic

Inlays and Onlays

Inlays and onlays, also called indirect fillings,

• Are made from gold, porcelain, or composite materials and fill decayed
or damaged teeth.
• Dental fillings are molded into place during an office visit; however, inlays
and onlays are created in a dental laboratory and bonded into place by the dentist.
• The filling is called an “inlay” when the material is bonded within the center
of a tooth
 • It is called an “onlay” when the filling includes one or more points of the tooth
or covers the biting surface.
• Inlays and onlays preserve as much healthy tooth as possible
and arealternative to crowns

ENDODONTIC TREATMENTS

• Root canal treatment is an often straightforward procedure to relieve dental

pain and save your teeth.
• Patients typically need a root canal when there is inflammation or infection in
the roots of a tooth.
• During root canal treatment the Endodontist who specializes in such treatment
carefully removes the pulp inside the tooth, cleans, disinfects and shapes the root
canals, and places a filling to seal the space.

HEMISECTION

• Hemisection denotes the removal of compromised root and the associated crown
portion with the loss of periodontal attachment and is performed to maintain
the original tooth structure and attain the fixed prosthesis
CONSERVATIVE AND ENDODONTICS CODES

• Types of CDT

1. Limited

2. Detailed or extensive

3. Revaluation

4. Revaluation post -op

ORAL EVALUATION

D0140- limited oral evaluation – problem focused

• An evaluation limited to a specific oral health problem.

• This may require interpretation of information acquired through additional
diagnostic procedures
• Report additional diagnostic procedures separately.
• Definitive procedures may be required on the same date as the
evaluation Typically, patients receiving this type of evaluation have been
referred for a specific problem and/or present with dental emergencies, trauma,
acute infections, etc
• Key words - “problem focused,” so it should only be billed for patients with
focused problems, not periodic evaluations

D0160- detailed and extensive oral evaluation – problem focused, by report

•

• A detailed and extensive problem-focused evaluation entails extensive

diagnostic and cognitive modalities based on the findings of a comprehensive oral
evaluation
 • Integration of more extensive diagnostic modalities to develop a treatment
plan for a specific problem is required
• The condition requiring this type of evaluation should be described and
documented

Examples of conditions requiring this type of evaluation may include

• Dentofacial anomalies,
• Complicated perio-prosthetic conditions,
• Complex temporomandibular dysfunction,
• Facial pain of unknown origin, severe systemic diseases requiring multi-
disciplinary consultation, etc

D0170 -
Re-evaluation-limited, problem focused (established patient; not post- operative visit)

• Assessing the status of a previously existing condition

For example:
• A traumatic injury where no treatment was rendered but patient needs follow-
up monitoring
• Evaluation for undiagnosed continuing pain;
• Soft tissue lesion requiring follow-up evaluation

D0171
Re-evaluation – post-operative office visit

TESTS & LABORATORY EXAMINATIONS

D0460
pulp vitality tests Includes multiple teeth and contra lateral comparison(s), as indicated
RESTORATIVE CODES(D2000-D2999)

Local anesthesia is part of Restorative procedures

• A one-surface posterior restoration - the restoration involves only one of

the five surface classifications (mesial, distal, occlusal, lingual, or facial,
including buccal and labial.)
• A two-surface posterior restoration is one in which the restoration extends
to two of the five surface classifications.
• A three-surface posterior restoration is one in which the restoration extends
to three of the five surface classifications.

• A four-or-more surface posterior restoration –

The restoration extends to four or more of the five surface classifications.

• A one-surface anterior proximal restoration –

Neither the lingual nor facial margins of the restoration extend beyond the line angle

• A two-surface anterior proximal restoration –

Either the lingual or facial margin of the restoration extends beyond the line angle

• A three-surface anterior proximal restoration –

Both the lingual and facial margins of the restorations extend beyond the line angle

• A four-or-more surface anterior restoration –

Both the lingual and facial margins extend beyond the line angle and the incisal angle is
involved
This restoration might also involve all four surfaces of an anterior tooth and not involve the
incisal angle
OTHER RESTORATIVE SERVICES

D2940
D2940

Protective restoration

• Direct placement of a temporary restorative material to protect tooth and/or tissue

form

• This procedure may be used to relieve pain, promote healing or prevent further
deterioration

• Not to be used for endodontic access closure, or as a base or liner under a restoration

D2950

Core buildup, including any pins

• Refers to building up of coronal structure when there is insufficient retention for a

separate extracoronal restorative procedure.

• A core buildup is not a filler to eliminate any undercut, box form, or concave
irregularity in a preparation

D2955

Post removal

CHALLENGES IN CODING

• How to code for procedures when they are done in more than one appointment

• What things are considered a part of the root canal

• which radiographs are a part of the root canal procedure

• What things can be coded separately

 • CDT Code entries for procedures that involve pulpal regeneration are clear, but they
are less commonly used and can be confusing unless the process has been studied by
the office coding specialist.

ENDODONTICS CODES(D3000-D3999)

Pulp Capping

D3110

• Pulp cap – direct (excluding final restoration)

• Procedure in which the exposed pulp is covered with a dressing or cement that
protects the pulp and promotes healing and repair

D3120

Pulp cap – indirect (excluding final restoration)

• Procedure in which the nearly exposed pulp is covered with a protective dressing to
protect the pulp from additional injury and to promote healing and repair via
formation of secondary dentin

• This code is not to be used for bases and liners when all caries has been removed

Pulpotomy

D3220

Therapeutic pulpotomy (excluding final restoration) –

• removal of pulp coronal to the dentinocemental junction and application

of medicament.

• Pulpotomy is the surgical removal of a portion of the pulp with the aim of maintaining
the vitality of the remaining portion by means of an adequate dressing
 • to be performed on primary or permanent teeth

• This is not to be construed as the first stage of root canal therapy.

• This is not to be used for apexogenesis

D3221

pulpal debridement, primary and permanent teeth

• Pulpal debridement for the relief of acute pain prior to conventional root canal
therapy

• This procedure is not to be used when endodontic treatment is completed on the same
day

D3222

partial pulpotomy for apexogenesis – permanent tooth with incomplete root

development

• Removal of a portion of the pulp and application of a medicament with the aim of
maintaining the vitality of the remaining portion to encourage continued physiological
development and formation of the root.

• This procedure is not to be construed as the first stage of root canal therapy

ENDODONTIC THERAPY, INCLUDING TREATMENT PLAN AND FOLLOW UP

Includes all appointments necessary to complete treatment; also includes intra-operative

radiographs Does not include diagnostic evaluation and necessary radiographs/diagnostic
images

D3331

Treatment of root canal obstruction; non-surgical access

 • In lieu of surgery, the formation of a pathway to achieve an apical seal without
surgical intervention because of a non-negotiable root canal blocked by foreign
bodies, included but not limited to separated instruments, broken posts or calcification
of 50% or more of the roots

D3332

incomplete endodontic therapy; inoperable, unrestorable or fractured tooth

• Considerable time is necessary to determine diagnosis and/or provide initial treatment

before the fracture makes the tooth unretainable

D3333

internal root repair of perforation defects

• Non-surgical seal or perforation caused by resorption and/or decay but not iatrogenic
by provider filing claim

ENDODONTIC RETREATMENT

D3346

retreatment of previous root canal therapy – anterior

D3347

retreatment of previous root canal therapy – bicuspid

D3348

retreatment of previous root canal therapy – molar

APEXIFICATION/RECALCIFICATION

D3351

Apexification/recalcification – initial visit (apical closure/calcific repair of perforations,

root resorption, etc.)

• Includes opening tooth, preparation of canal spaces, first placement of medication and
necessary radiographs. (This procedure may include first phase of complete root canal
therapy )

D3352

Apexification/recalcification – interim medication replacement (apical closure/calcific repair

of perforations, root resorption, pulp space, disinfection, etc.)

• For visits in which the intra-canal medication is replaced with new medication
includes any necessary radiographs

D3353

Apexification/recalcification – final visit (includes completed root canal therapy – apical

closure/calcific repair of perforations, root resorption, etc.)

• Includes removal of intra-canal medication and procedures necessary to place

final root canal filling material including necessary radiographs.

• This procedure includes last phase of complete root canal therapy

PULPAL REGENERATION

D3355

Pulpal regeneration – initial visit

• Includes opening tooth, preparation of canal spaces, placement of medication

D3356

Pulpal regeneration – interim medication replacement

D3357

Pulpal regeneration – completion of treatment

• Does not include final restoration.

APICOECTOMY/PERIRADICULAR SERVICES

Periradicular surgery is the

• surgery to the root surface (e g apicoectomy)

• repair of a root perforation or resorptive defect

• exploratory curettage to look for root fractures

• removal of extruded filling materials or instruments

• removal of broken root fragments

• sealing of accessory canals, etc

 • This does not include retrograde filling material placement.

D3410

Apicoectomy – anterior

• For surgery on root of anterior tooth.

• Does not include placement of retrograde filling material

D3421

Apicoectomy – bicuspid (first root)

• For surgery on one root of a bicuspid.

• Does not include placement of retrograde filling material

D3425

Apicoectomy – molar (first root)

• For surgery on one root of a molar tooth.

• Does not include placement of retrograde filling material

D3426

Apicoectomy (each additional root)

• Typically used for bicuspids and molar surgeries when more than one root is treated
during the same procedure.

• This does not include retrograde filling material placement.

D3428

Bone graft in conjunction with periradicular surgery – per tooth, single site

• Includes non-autogenous graft material

D3429

Bone graft in conjunction with periradicular surgery – each additional contiguous tooth in the
same surgical site

• Includes non-autogenous graft material

D3430

Retrograde filling – per root

• For placement of retrograde filling material during periradicular surgery procedures.

• If more than one filling is placed in one root, report as D3999 and describe.
D3450

Root amputation – per root

• Root resection of a multi-rooted tooth while leaving the crown

D3460

Endodontic endosseous implant

• Placement of implant material which extends from a pulpal space into the bone
beyond the end of the root

D3470

Intentional reimplantation (including necessary splinting)

• For the intentional removal, inspection and treatment of the root and replacement of
a tooth into its own socket.

• This does not include necessary retrograde filling material placement

OTHER ENDODONTIC PROCEDURE

D3910

Surgical procedure for isolation of tooth with rubber dam

D3920

Hemisection (including any root removal), not including root canal therapy Includes

• separation of a multi-rooted tooth into separate sections containing the root and the
overlying portion of the crown

• It may also include the removal of one or more of those sections

D3950

Canal preparation and fitting of preformed dowel or post

• Should not be reported in conjunction with D2952, D2953, D2954 or D2957 by the
same practitioner

D3999

Unspecified endodontic procedure, by report

• Used for procedure that is not adequately described by a code

• Describe procedure

CODES NOT USED IN AN ENDODONTIC PRACTICE

D0120

Periodic oral evaluation – established patient

• Used for new patient exams administered by a general dentist or periodontist.

D0150

• Comprehensive oral evaluation – new or established

MEDICALLY NECESSARY DIAGNOSIS(NOT LIMITED TO THE LISTED
DIAGNOSIS)
PROSTHODONTICS

Prosthodontics , also known as dental prosthetics or prosthetic dentistry, is the

area of dentistry that focuses on dental prostheses
• A prosthodontist is a dentist who:
• Specializes in the aesthetic (cosmetic) restoration and replacement of teeth.
• Restores optimal appearance and function to your smile.
• The planning, surgical placement and restoration of implants and rehabilitation
of occlusion with prostheses .

 Dentures (also known as false teeth) are prosthetic devices constructed to replace
missing teeth
 Dentures are supported by the surrounding soft and hard tissues of the oral cavity

Dentures

Complete Denture Prosthesis

The treatment for totally missing teeth patients

 Replacement of single arch is also done in the form of Single Complete Denture

Removable partial dentures

This treatment is carried out for patients who have few missing teeth.
 These are removable dentures that take support from the adjacent teeth.
 Deals with the replacement of missing teeth using a removable artificial substitute
that can readily be removed by the patient.
 Overdentures

These are done in patients where two healthy teeth are present. These teeth are
used to improve the fit, comfort and function of the dentures

Immediate dentures

As the name suggests these dentures are given immediately after extraction of the
teeth.
 The prosthesis is fabricated before the extraction and placed immediately after the
tooth is extracted.
 This is done for people who cannot be without teeth at all, like, socially active
people or for psychological reasons.

REPARING, RELINING OR REBASING

• An ill-fitting complete denture may cause various lesions on mucosa and
inflammatory overgrowth could appear
• So, reparing, relining or rebasing the denture will certainly resolve the problem.

Repairing
• Denture may fracture during the function, or may drop on a hard surface. So the
key of repairing is the accurate reassembling and alignment of the broken parts in their
original position.

Relining
Resurfacing or correction of denture adaptation to underlying tissues by the
addition of a new resin material to its fitting surface without changing its occlusal
relation. Addition of material to the tissue side of a denture to improve its adaptation to
the supporting mucosa.

Rebasing

It is the process of replacing all the base material of a denture

Fixed partial dentures (crowns and bridges)

This deals with the replacement of missing teeth using fixed artificial substitutes
that remain fixed either to the adjacent teeth or to dental implants.
 This treatments carried out for patients who have
 one or few missing teeth,
 root canal treated tooth,
 badly broken down tooth,
 discolored tooth.
 The various treatments rendered are cap/ crown for root canal treated tooth,
bridge for one or few teeth missing.
 A bridge is a fixed dental restoration used to replace one or more missing teeth by
joining an artificial tooth definitively to adjacent teeth or dental implants.

Full mouth rehabilitation

This is done for the cases which require treatment for all the teeth.
 Materials used for this treatment are metal, metal ceramic and metal-free ceramic
and implants.

Implant prosthesis

Dental implants are the most advanced form of replacing missing teeth
 These are small titanium screws with prosthesis that are inserted into areas of
missing teeth in order to provide a tooth like substitute

Maxillofacial Prosthodontics

 Deals with the treatment of patients with congenital and acquired defects of the
head and neck region.
 Integrates parts of multiple disciplines including head and neck oncology,
congenital malformation, plastic surgery, speech and other related disciplines
 Deals with restoration of acquired defects, which may be intra oral or extra oral
 Intra oral defects may involve the maxilla, mandible, tongue, soft palate or hard
palate
 While extra oral defects may involve any other area of the head or neck like.. Ears,
eyes, nose, fingers etc.
Aesthetic prosthodontics
• Most advanced approach to providing the best smiles utilizing the sophisticated
principles of smile designing
• Dental veneers and other bonded restorations fall into the category of cosmetic
dentistry & smile designing; and are used to create bright smiles with beautifully shaped
teeth.
• These types of restorations may solve most or all of the issues, including severe tooth
discoloration, chips ,cracks and the wear and tear that causes uneven teeth.

Gnathology
Includes Temporomandibular Joint And Other Related Disorders
 Provides treatments for jaw problems caused by temporomandibular joint
disorder (TMD), snoring disorder, sleep apnea problems, and some degree of
reconstruction following treatments/surgery for oral cancer.
 Prosthodontists work closely with periodontists, endodontists, oral surgeons and
orthodontists to elicit the finest restorative results for the patients.

PROSTHODONTICS CODES

PROSTHETICS

• Is the art and science of supplying artificial replacements for missing parts of the
human body
• Prosthesis is an artificial replacement for an absent part of the human body
• Prosthodontics is the restoration of natural teeth and the replacement of missing teeth
and associated structures with artificial substitutes

THE DIVISION OF PROSTHODONTICS

• Prosthodontics has three major divisions:
• (1) fixed prosthodontics,
• (2) removable prosthodontics,
• (3) maxillofacial prosthetics.
• Removable prosthodontics is subdivided into
 • Removable partial denture prosthodontics
• Complete denture prosthodontics

INDICATIONS FOR RPDs

 FPD Not Possible
 Distal Abutment Tooth
 Patient Can Not Afford More Desirable Treatmen

CDT Code
D5120 Complete denture – mandibular

D5130 Immediate denture – maxillary

D5140 Immediate denture – mandibular

D5211 Maxillary partial denture – resin base (including retentive/clasping

materials, rests, and teeth)

D5212 Mandibular partial denture – resin base (including retentive/clasping

materials, rests, and teeth)

D5213 Maxillary partial denture – cast metal framework with resin denture bases
(including any conventional clasps, rest and teeth)

D5214 Mandibular partial denture – cast metal framework with resin denture
bases (including any conventional clasps, rest and teeth)
D5221

Immediate maxillary partial denture – resin base (including any conventional

clasps, rests and teeth)

D5222

Immediate mandibular partial denture – resin base (including any conventional

clasps, rests and teeth)

D5223

Immediate maxillary partial denture – cast metal framework with resin denture
bases (including any conventional clasps, rest and teeth)

D5224

Immediate mandibular partial denture – cast metal framework with resin denture
bases (including any conventional clasps, rest and teeth)

D5225

Maxillary partial denture - flexible base (including retentive/clasping materials,

rests, and teeth)

D5226

Mandibular partial denture - flexible base (including retentive/clasping materials,

rests, and teeth)

D5282

Removable unilateral partial denture – one piece cast metal (including

retentive/clasping materials, rests, and teeth), maxillary

D5283

Removable unilateral partial denture – one piece cast metal (including

retentive/clasping materials, rests, and teeth), mandibular
D5284

Removable unilateral partial denture – one piece flexible base (including

retentive/clasping materials, rests, and teeth – per quadrant

D5286

removable unilateral partial denture – one piece resin (including retentive/clasping

materials, rests, and teeth) – per quadrant

D5410

Adjust complete denture – maxillary

D5411

Adjust complete denture – mandibular

D5421

Adjust partial denture – maxillary

D5422

Adjust partial denture – mandibular

D5511

Repair broken complete denture base, mandibular

D5512

Repair broken complete denture base, maxillary

D5520

Replace missing or broken teeth – complete denture (each tooth)

 D5611

Repair resin partial denture base, mandibular

D5612

Repair resin partial denture base, maxillary

D5621

Repair cast partial framework, mandibular

D5622

Repair cast partial framework, maxillary

D5630 Repair or replace broken retentive/clasping materials – per tooth

D5640

Replace broken teeth – per tooth

D5650

Add tooth to existing partial denture

D5660

Add clasp to existing partial denture – per tooth

D5670

Replace all teeth and acrylic on cast metal framework (maxillary)

D5671

Replace all teeth and acrylic on cast metal framework (mandibular)

D5710

Rebase complete maxillary denture

D5711

Rebase complete mandibular denture

D5720

Rebase maxillary partial denture

D5721

Rebase mandibular partial denture

D5730

Reline complete maxillary denture (direct)

D5731

Reline complete mandibular denture (direct)

D5740

Reline maxillary partial denture (direct)

D5741

Reline mandibular partial denture (direct)

D5750

Reline complete maxillary denture (indirect)

D5751

Reline complete manibular denture (indirect)

D5760

Reline maxillary partial denture (indirect)

D5761

Reline mandibular partial denture (indirect)

D5810

Interim complete denture (maxillary)

D5811

Interim complete denture (mandibular)

D5820

Interim partial denture (including retentive/clasping materials, rests, and teeth),

maxillary

D5821

Interim partial denture (including retentive/clasping materials, rests, and teeth),

mandibular

D5850

Tissue conditioning, maxillary

D5851

Tissue conditioning, mandibular

D5862

Precision attachment, by report

D5863

Overdenture – complete maxillary

D5864

Overdenture – partial maxillary

D5865

Overdenture – complete mandibular

D5866 Overdenture – partial mandibular

D5867

Replacement of replaceable part of semi-precision for precision attachment (male

or female component)
 D5875

Modification of removable prosthesis following implant surgery

D5876

Add metal substructure to acrylic full denture (per arch)

D5899

Unspecified removable prosthodontic procedure, by report

Billing and Coverage

Examples

Coverage Limitations
(varies based on payers)

Complete and Partial Dentures

• Limited to once per 60 months

• No additional allowances for precision or semi-precision attachments

• Subject to a 12 month Waiting Period

Complete and Partial Denture Rebase and Reline Procedures

Limited to Relining/Rebasing performed more than 6 months after the initial
insertion
 • Limited to 1 time per consecutive 12 months

Fixed Partial Dentures (FPD)

Fixed partial dentures may be indicated for the following:

 Replacement of missing permanent teeth in which the Retainer/Abutment teeth

have a favorable long term prognosis
 Replacement of one to two missing teeth in a Tooth Bounded Space
 Resin bonded appliances (e.g., Maryland Bridge) are indicated for the replacement
of one missing tooth and un-restored /undamaged retainer/abutment teeth

Provisional Fixed Partial Dentures

 Provisional fixed partial dentures may be indicated for the following:
 When a permanent fixed partial denture does not have a favorable long term
prognosis
 To replace a lost tooth in young members to allow maturity of the dentition and
jaws before constructing a definitive fixed prosthetic appliance
 When a systemic medical condition prohibits the placement of a definitive fixed
prosthetic appliance

 Cantilever Fixed Dental Prosthesis:

A Fixed complete or partial denture in which the Pontic is cantilevered, (i.e., is

retained and supported only on one end by one or more Abutments).
 Connector Bar:

A device attached to fixed partial denture Retainer or coping which serves to

stabilize and anchor a removable overdenture prosthesis.
 Precision Attachment:

An interlocking device, one component of which is fixed to an Abutment or

Abutments, and the other is integrated into a removable dental prosthesis in order
to stabilize and/or retain it.

Resin-Bonded Prosthesis (e.g., Maryland Bridge):

 A Fixed Dental Prosthesis that is luted to tooth structures, primarily enamel,
which has been etched to provide mechanical retention for the resin cement.

Retainers:
 Any type of device used for the stabilization or retention of prosthesis.
 Tooth Bounded Space: A space created by one or more missing teeth that has a
tooth on each side.

Stress Breaker (a Non-Rigid Connector)

Stress Breakers may be indicated for the following:

• When it is not possible to prepare two Retainers/Abutments with a common path of

placement

• When the prognosis of a Retainer/Abutment is uncertain

• Control of loading and rotational forces

• Redistribution of occlusal forces

CDT CODES
• D6205
Pontic – indirect resin based composite

• D6210
Pontic – cast high noble metal
• D6211
Pontic – cast predominantly base metal

• D6212
Pontic – cast noble metal

• D6214
Pontic – titanium and titanium alloys

• D6240
Pontic – porcelain fused to high noble metal

• D6241
Pontic – porcelain fused to predominantly

• D6242
Pontic – porcelain fused to noble metal

• D6243
Pontic – porcelain fused to titanium and titanium alloys

• D6245
Pontic – porcelain/ceramic

D6250
Pontic – resin with high noble metal

D6251
Pontic – resin with predominantly base metal

D6252
Pontic – resin with noble metal

D6253
Provisional pontic – further treatment or completion of diagnosis necessary prior to final
impression

D6545
Retainer – cast metal for resin bonded fixed prosthesis

D6548
Retainer – porcelain/ceramic for resin bonded fixed prosthesis

D6549
Resin retainer – for resin bonded fixed prosthesis

D6600
Retainer inlay – porcelain/ceramic, two surfaces
D6601
Retainer inlay – porcelain/ceramic, three or more surfaces

D6602
Retainer inlay – cast high noble metal, two surfaces

D6603
Retainer inlay – cast high noble metal, three or more surfaces

D6604
Retainer inlay – cast predominantly base metal, two surfaces
D6605

Retainer inlay – cast predominantly base metal, three or more surfaces

D6606

Retainer inlay – cast noble metal, two surfaces

D6607

Retainer inlay – cast noble metal, three or more surfaces

D6608

Retainer onlay – porcelain/ceramic, two surfaces

D6609
Retainer onlay – porcelain/ceramic, three or more surfaces

D6610
Retainer onlay – cast high noble metal, two surfaces

D6611
Retainer onlay – cast high noble metal, three or more surfaces

D6612
Retainer onlay – cast predominantly base metal, two surfaces

D6613
Retainer onlay – cast predominantly base metal, three or more surfaces

D6614
Retainer onlay – cast noble metal, two surfaces

D6615
Retainer onlay – cast noble metal, three or more surfaces
D6624
Retainer inlay – titanium

D6634
Retainer onlay – titanium

D6710
Retainer crown – indirect resin based composite

D6720

Retainer crown – resin with high noble metal

D6721

Retainer crown – resin with predominantly base metal

D6722

Retainer crown – resin with noble metal

D6740

Retainer crown – porcelain/ceramic

D6750

Retainer crown – porcelain fused to high noble metal

D6751

Retainer crown – porcelain fused to predominantly base metal

D6752

Retainer crown – porcelain fused to noble metal

D6753

Retainer crown – porcelain fused to titanium and titanium alloys

D6780

Retainer crown – 3/4 cast high noble metal

D6781

Retainer crown – 3/4 cast predominantly base metal

D6782

Retainer crown – 3/4 cast noble metal

D6783

Retainer crown – 3/4 porcelain/ceramic

D6784

Retainer crown – 3/4 titanium and titanium alloys

D6790

Retainer crown – full cast high noble metal

D6791

Retainer crown – full cast predominantly base metal

D6792

Retainer crown – full cast noble metal

 D6793

Provisional retainer crown – further treatment or completion of diagnosis

necessary prior to final impression

D6794

Retainer crown – titanium and titanium alloys

D6920

Connector bar

D6930

Re-cement or re-bond fixed partial denture

D6940

Stress breaker

D6950

Precision attachment

D6980

Fixed partial denture repair necessitated by restorative material failure

D6985

Pediatric partial denture, fixed

D6999

Unspecified fixed prosthodontic procedure, by report

Billing and Coverage

Varies from payers

Coverage Limitations

❖ Repairs or adjustments performed more than 12 months after the initial insertion;
limited to 1 per consecutive 6 months
❖ Subject to a 12 month Waiting Period

Exclusions
Replacement of fixed prosthesis previously submitted for payment under the plan is limited
to 1 time per consecutive 60 months from initial or supplemental placement
• Limited to 1 time per tooth per consecutive 60 months
• Stress breakers, and Connector Bars are not covered Clinical situations that can be
effectively treated by a less costly alternative procedure will be assigned a benefit based
on the least costly procedure
• Any Dental Procedure performed solely for cosmetic/aesthetic reasons (cosmetic
procedures are those procedures that improve physical appearance)

Maxillofacial Prosthetics
• Clinical situations that can be effectively treated by a less costly, dental appropriate
alternative procedure will be assigned a benefit based on the least costly procedure
• Any Dental Procedure performed solely for cosmetic/aesthetic reasons (cosmetic
procedures are those procedures that improve physical appearance)
• Any Dental Procedure not directly associated with dental disease
• Replacement of complete dentures, and removable partial dentures (such as
connectors), if damage or breakage was directly related to provider error. This type of
replacement is the responsibility of the Dental Provider. If replacement is due to
patient non-compliance, the patient is liable for the cost of replacement.

Removable prosthodontic restoration procedures for complete oral rehabilitation or

reconstruction

 Attachments to conventional removable prostheses. This includes semi-precision

or precision attachments associated with
 partial dentures, full or partial Overdentures, and any elective endodontic
procedure related to a tooth or root involved in the construction of a prosthesis of
this nature.
ORTHODONTICS

Orthodontics is a specialty of dentistry that deals with the Diagnosis, Prevention, Correction.
Correction can be of malpositioned teeth and jaws, and misaligned bite patterns. It can also
focus on modifying facial growth, known as dentofacial orthopedics. A typical treatment for
incorrectly positioned teeth (malocclusion) takes about 1 to 3 years to complete, with braces
being altered slightly every 4 to 10 weeks by the specialists called orthodontists . A wide
range of treatment options to straighten crooked teeth, fix bad bites and align the jaws
correctly

Orthodontic diagnosis should be based on scientific knowledge combined at times with

clinical experience and common sense Comprehensive orthodontic diagnosis is established
by clinical implementation called diagnostic aids. Orthodontic diagnostic aids are of two
types

1. Essential diagnostic aids

2. Supplemental diagnostic aid

DIAGNOSTIC AIDS ESSENTIAL DIAGNOSTIC AIDS

They are clinical aids that are considered very important for all cases. The following are
essential diagnostic aids;

1. Case history

2. Clinical examination

3. Study models

4. Certain radiographs x Periapical x Bitewing x Panoramic

5. Facial photographs

DIAGNOSTIC AIDS SUPPLEMENTAL DIAGNOSTIC AIDS

• They are certain aids that are not essential in all cases
 • They may require specialized equipments

• The supplemental diagnostic aids include

1. Specialized radiographs cephlometric radiographs , occlusal intra-oral films , selected
lateral jaw views , cone shift technique

2. Electromyographic examination of muscle activity

[Link] wrist radiographs to assess bone age or maturation age

[Link] tests

[Link] of basal metabolic rate

[Link] set-up

[Link]

INDICATIONS FOR ORTHODONTIC TREATMENTS

Protruding front teeth: Treatment can improve the appearance and protects the teeth from
damage during sports injuries or falls.

Crowding: In a narrow jaw, there may not be enough space for all the teeth. The
orthodontist may remove one or more teeth to make room for the others.

Impacted teeth: This can happen when adult tooth does not emerge from the gum or bone,
or only emerges partially.

Asymmetrical teeth: The upper and lower teeth do not match, especially when the mouth is
closed but the teeth are showing.

Deep bite, or overbite: When the teeth are clenched, the upper ones come down too far over
the lower ones.

Reverse bite: When the teeth are clenched, the upper teeth bite inside the lower ones.
Open bite: When the teeth are clenched, there is an opening between the upper and lower
teeth.

Underbite: The upper teeth are too far back, or the lower teeth are too far forward.

Crossbite: At least one of the upper teeth does not come down slightly in front of the lower
teeth when the teeth are clenched. They are too near the cheek or the tongue.

Spacing: There are gaps or spaces between the teeth, either because a tooth is missing, or the
teeth do not fill-up the mouth. This is the opposite of crowding MALOCCLUSION

Angle’s classification for interarch relationship

ClassI:most common(maxillary mesiofacialcusp located inbthe mesiodevelopmental groove

of the mandibular first molar.

ClassII:posterior positioning of mandible to maxilla.

ClassIII:anterior positioning of mandible to maxilla.

DIAGNOSIS

• The assessment will involve:

• Taking a full medical and dental health history

• Carrying out a clinical examination

• Taking x-rays of the teeth and jaw

• Making plaster models of the teeth

• The orthodontist will decide on a treatment plan

TREATMENTS

• Closing wide gaps between the teeth

• Aligning the tips of the teeth

• Straightening crooked teeth

 • Improving speech or chewing ability

• Boosting the long-term health of gums and teeth

• Preventing long-term excessive wear or trauma of the teeth

• Treating an improper bite

ORTHODONTIC DEVICES

Orthodontic devices can be fixed or removable

Fixed appliances These are the most common devices used in orthodontics. They are used
when precision is important.

Fixed orthodontic appliances include

• Braces These consist of brackets, wires, and bands. Bands are fixed firmly around
the teeth and serve as anchors for the appliance, while brackets are usually connected
to the front of the teeth

• Wires in the shape of an arch pass through the brackets and are fixed to the bands. As
the arch wire is tightened, tension is applied to the teeth. Over time, this moves them
into proper position
Follow-up involves monthly visits to adjust or tighten the braces. Treatment may last from
several months to a number of years . Both clear and colored braces are available

Removable orthodontic appliances

• These may be used to treat minor problems, such as preventing thumb sucking or
correcting slightly crooked teeth.

• The appliance should only be taken out when cleaning, eating, or flossing

• Aligners: This alternative to braces may be useful for adults. x They are virtually
unnoticeable by other people, and they can be removed to brush the teeth, floss, or
eat. An aligner is used for 2 to 3 weeks, then changed for a tighter one

• Headgear: A strap around the back of the head is attached to a metal wire in the
front, or face bow. The aim is to slow down upper jaw growth, and keeping the back
teeth in position while the front ones are pulled back.
OTHER ORTHODONTIC DEVICES
 • Lip and cheek bumpers:These are specially made to relieve the pressure of cheeks
or lips on the teeth.

• Palatal expander:This appliance is designed to make the arch of the upper jaw
wider. It consists of a plastic plate with screws that is placed on the palate, or roof of
the mouth. The screws put pressure on the joints in the bones, forcing them outward.
This expands the size of the area in the roof of mouth

• Retainers: These are used after treatment to stop the teeth from moving back to their
original positions. If modified, they may also be used to stop children from sucking
their thumbs. There are two types of removable retainer:

A Hawley retainer is made of metal and acrylic.

• The acrylic fits on the roof of the mouth and the wire surrounds the anterior teeth.

• The other is made of clear plastic. It fits over the teeth and looks like an Invisalign
aligner. Hawley retainer Clear retainer

PERMANENT RETAINERS

• Are glued, or bonded, to the back of the teeth.

• It is usually recommended for lower anterior teeth because of the high risk of
reverting back to their former position.
In some cases, orthodontists recommend both a fixed permanent one on the lower anterior
teeth and the clear plastic aligner-type which then would fit over the entire lower arch

Splints, or jaw repositioning appliances

 • These are placed either in the top or lower jaw.

• They help the jaw close properly

• Splints are commonly used for temporomandibular joint disorder (TMJ).

• TMJ is a condition that can cause pain and dysfunction in the muscles that are involve
in jaw movement.

• It is important to follow both the health professional’s instructions and oral hygiene
guidelines with care, to ensure the best outcome

CODING TIPS:

FOCUS Age of patient

Diagnosis

Types of treatment

Removal/permanent appliances

ORTHODONTIC CODES

DENTITION

Primary Dentition:
 • Teeth developed and erupted first in order of time.
Transitional Dentition:
• The final phase of the transition from primary to adult teeth, in which the
deciduous molars and canines are in the process of shedding and the permanent successors
are emerging.
Adolescent Dentition:
• The dentition that is present after the normal loss of primary teeth and prior
to cessation of growth that would affect orthodontic treatment.
Adult Dentition:
• The dentition that is present after the cessation of growth that would
affect orthodontic treatment.

LIMITED ORTHODONTIC TREATMENT

Orthodontic treatment with a limited objective, not necessarily involving the entire dentition
It may be directed at the only existing problem, or at only one aspect of a larger problem
in which a decision is made to defer or forego more comprehensive therapy

D8010
Limited orthodontic treatment of the primary dentition

D8020
Limited orthodontic treatment of the transitional dentition

D8030
Limited orthodontic treatment of the adolescent dentition

D8040
Limited orthodontic treatment of the adult dentition

INTERCEPTIVE ORTHODONTIC TREATMENT

 • Interceptive orthodontics is an extension of preventive orthodontics that may include
localized tooth movement.
• Such treatment may occur in the primary or transitional dentition and may include
such procedures as
•The redirection of ectopically erupting teeth,
•Correction of dental cross bite or recovery of space loss where overall space is
inadequate
• When initiated during the incipient stages of a developing problem,
interceptive orthodontics may reduce the severity of the malformation and mitigate
its cause.
• Complicating factors such as skeletal disharmonies, overall space deficiency, or other
conditions may require subsequent comprehensive therapy

D8050
Interceptive orthodontic treatment of the primary dentition

D8060
Interceptive orthodontic treatment of the transitional dentition

COMPREHENSIVE ORTHODONTIC TREATMENT

• Comprehensive orthodontic care includes a coordinated diagnosis and treatment

leading to the improvement of a patient’s craniofacial dysfunction and/or dentofacial
deformity which may include anatomical, functional and/or aesthetic relationships
• Treatment may utilize fixed and/or removable orthodontic appliances and may also
include functional and/or orthopedic appliances in growing and non-growing patients
• Adjunctive procedures to facilitate care may be required.
• Comprehensive orthodontics may incorporate treatment phases Focusing on specific
objectives at various stages of dento facial development
D8070
Comprehensive orthodontic treatment of the transitional dentition
•

D8080
Comprehensive orthodontic treatment of the adolescent dentition
•

D8090
Comprehensive orthodontic treatment of the adult dentition

MINOR TREATMENT TO CONTROL HARMFUL HABITS

D8210
Removable appliance therapy
Removable indicates patient can remove; includes appliances for thumb sucking and
tongue thrusting.
D8220
Fixed appliance therapy
Fixed indicates patient cannot remove appliance; includes appliances for thumb sucking
and tongue thrusting

OTHER ORTHODONTIC SERVICES AND ANCILLARY CODES

D8660
Pre-orthodontic treatment examination to monitor growth and development –
Periodic observation of patient dentition, at intervals established by the dentist, to determine
when orthodontic treatment should begin.
• Diagnostic procedures are documented separately
D8690
Orthodontic treatment (alternative billing to a contract fee) –

Services provided by dentist other than original treating dentist

A method of payment between the provider and responsible party for services that reflect an
open-ended fee arrangement

D8691
Repair of orthodontic appliance-

• Does not include bracket and standard fixed orthodontic appliances.

• It does include functional appliances and palatal expanders

D0150
Comprehensive oral evaluation – new or established patient –
• Used by a general dentist and/or a specialist when evaluating a
patient comprehensively.
• This applies to new patients; established patients who have had a significant change in
health conditions or other unusual circumstances, by report, or established patients who
have been absent from active treatment for three or more years.
• It is a thorough evaluation and recording of the extraoral and intraoral hard and soft
tissues.

• It may require interpretation of information acquired through

additional diagnostic procedures.
• Additional diagnostic procedures should be reported separately.
• This includes an evaluation of oral cancer where indicted, the evaluation
and recording of the patient’s dental and medical history and a general health assessment.
• It may include the evaluation and recording of dental caries, missing
or unerupted teeth, restorations, existing prosthesis, occlusal relationships, periodontal
 conditions (including periodontal screening and/or charting), hard and soft tissue
anomalies, etc

D0340
2D Cephalometric radiographic image –acquisition, measurement and analysis
Image of the head made using a cephalostat to standardize anatomic positioning, and
with reproducible x-ray beam geometry

D0351
3D photographic image

This procedure is for dental or maxillofacial diagnostic purposes.

Not applicable for a CAD-CAM procedure

D7880
Occlusal orthotic device, by report –
Presently includes splints provided for treatment of temporomandibular joint dysfunction

D9450
Case presentation, detailed and extensive treatment planning

Established patient. Not performed on same day as evaluation.

D9940

Occlusal guard, by report

Removable dental appliances, which are designed to minimize the effects of bruxism
(grinding) and other occlusal factors.
WHAT ORTHODONTIC TREATMENT
AND ORTHODONTICRELATED SERVICES ARE NOT COVERED BY
CERTAIN AGENCY?

Orthodontic treatment provided after the client’s 21st birthday (treatment provided after the
client’s 21st birthday is the financial responsibility of the client).
• Case studies that do not include a definitive treatment plan.
• Orthodontic treatment for cosmetic purposes.
• Orthodontic treatment that is not medically necessary
.

Orthodontic treatment provided out-of-state

Exception: Providers in agency-designated bordering cities may be eligible for payment for
services provided to agency clients.
See Provider Requirements for information.
• Orthodontic treatment and related services that do not meet the requirements listed in this
billing guide

ORTHODONTIC SERVICES BILLING GUIDE

(VARIES FROM PAYERS TO PAYERS)

WHAT IS PRIOR AUTHORIZATION (PA)

• For bigger dental treatments, a dentist may be required to file a prior authorization
before you get a service to see if the service will be covered
 • Dentists use the pre-authorization process to determine a patient's coverage
• Sometimes a treatment plan has been pre-authorized or pre-approved by the carrier
and the treatment is performed by the dentist with the expectation that the claim will be
paid, but it is denied.

SAMPLE COVERAGE TABLE

GENERAL CLINICAL EVALUATIONS

CDT DESCRIPTION PA LIMITATIONS/REQUIREMENTS

CODE
D0160 Detailed and NO Includes orthodontic oral examination,
extensive oral taking and processing clinical
evaluation photographs, completing required
– orthodontic only form(s) and obtaining the
agency’s authorization decision.
Allowed once per client, per
billing provider
D0170 Re-evaluation – NO Not allowed in combination
limited, problem with periodic/limited/comprehensive oral
focused (established evaluations. Allowed once per client, per
patient; not post- billing provider, per year until appliances
operative visit are placed

COVERAGE TABLE
XRAYS/RADIOGRAPHS
 CDT Description PA? Limitations/ Requirements
Code

D0330 Panoramic film No Included in case study. The agency covers

– maxilla panoramic films once every 3 years.
and mandible *Additional films require prior authorization.
Panoramic films are not required when
submitting prior authorization requests
for orthodontic services unless the request
indicates that the client has an impacted tooth
or teeth.
D0340 Cephalometric film Yes Included in case study. Additional films require
prior authorization. Cephalometric films are not
required when submitting prior authorization
requests for orthodontic services unless the
request indicates that the client has a negative
overjet.

OTHER ORTHODONTIC SERVICES

CDT Code Description PA Limitations/ Requirements

D8220 Fixed appliance YES Considered for a Thumb Crib
therapy
D8680 Appliance removal, EPA Prior authorization is required if the EPA
construction criteria is not met. Do not bill in conjunction
and placement of with CDT code D8695
retainers
D8703 Replacement of lost or YES Initial retainer is included in initial payment.
broken retainers -
maxillary
D8704 Replacement of lost or YES Initial retainer is included in initial payment.
broken retainers
– mandibular
D8695 Appliance removal EPA Prior authorization is required if the EPA
criteria is not met. Do not bill in conjunction
with CDT code D8680.

SEVERE HANDICAPPING MALOCCLUSION, CLEFT LIP AND PALATE, CLEFT

PALATE, OR CLEFT LIP WITH ALVEOLAR PROCESS INVOLVEMENT

CLINICAL EVALUATIONS

CDT® Description PA? Limitations/ Requirements

Code
D8660 Pre-orthodontic visit yes Use this code for Orthodontist Case Study. Billable
only by the treating orthodontic provider.
Includes preparation of comprehensive diagnostic
records (additional photos, study
casts, cephalometric examination film, and
panoramic film), formation of diagnosis and
treatment plan from such records, and formal case
conference
D8020 Limited yes This reimbursement is for the initial placement when
orthodontic treatment the appliance placement date and the date of service
of are the same. Includes first three months of treatment
transitional dentition and appliance(s)

D8020 Limited yes This reimbursement is for each subsequent three-

orthodontic treatment month period when the appliance placement date and
of the date of service are different. The
transitional dentition agency reimburses a maximum of three follow-up
visits.

D8030 Limited yes This reimbursement is for the initial placement when
orthodontic treatment the appliance placement date and the date of service
of the adolescent are the same. Includes first three months of treatment
dentition and appliance(s)
INTERCEPTIVE ORTHODONTICS

Description Interceptive orthodontic treatment PA? Limitations/ Requirements

of the transitional dentition

D8060 Interceptive orthodontic treatment yes The maximum allowance

of the transitional dentition includes all professional
fees, laboratory costs,
and required follow-up

COMPREHENSIVE ORTHODONTIC TREATMENT

CDT Code Description PA? Limitations/ Requirements

D8080 Comprehensive orthodontic yes This reimbursement is for

treatment of the the initial placement when
adolescent dentition the appliance placement
date and the date of service
are the same. Includes first
six months of treatment
and appliances
D8080 Comprehensive orthodontic yes This reimbursement is
treatment of the for each subsequent three-
adolescent dentition month period when the
appliance placement date
and the date of service are
different. The agency
reimburses a maximum of
eight follow-up visits.
PEDODONTICS

Dental specialty that deals with the care of children’s teeth

The pedodontist is extensively concerned with
• Prevention, which includes instruction in proper diet, use of fluoride, and practice
of oral hygiene.
• The routine practice deals basically with caries (tooth decay) but includes
influencing tooth alignment

• One of the most important components of pediatric dentistry is child psychology.

• Pediatric dentists are trained to create a friendly, fun, social atmosphere for
visiting children

WHAT DOES A PEDIATRIC DENTIST DO?

• Pediatric dentists fulfill many important functions pertaining to the child’s overall oral
health and hygiene
• They place particular emphasis on the proper maintenance and care of deciduous
(baby) teeth, which are instrumental in facilitating good chewing habits, proper speech
production
• Hold space for permanent teeth

OTHER IMPORTANT FUNCTIONS

Education
Pediatric dentists educate the child using
• Models,
• Computer technology,
• And child-friendly terminology,
Thus emphasizing the importance of keeping teeth strong and healthy.
In addition, they advise parents on disease prevention, trauma prevention, good eating
habits, and other aspects of the home hygiene routine.
Monitoring growth
By continuously tracking growth and development, pediatric dentists are able
to anticipate dental issues and quickly intervene before they worsen.
Also, working towards earlier corrective treatment preserves the child’s self-esteem
and fosters a more positive self-image

Prevention
• Helping parents and children establish sound eating and oral care habits reduces the
chances of later tooth decay.
• In addition to providing check ups and dental cleanings, pediatric dentists are also
able to apply dental sealants and topical fluoride to young teeth, advise parents on thumb-
sucking/pacifier/smoking cessation, and provide good demonstrations of brushing and
flossing.
Intervention
• In some cases, pediatric dentists may discuss the possibility of early oral treatments
with parents. In the case of oral injury, malocclusion (bad bite), or bruxism (grinding),
space maintainers may be fitted, a nighttime mouth guard may be recommended, or
reconstructive surgery may be scheduled.

PEDIATRICS DENTAL EXAMINATION AND DIAGNOSIS

Patient Records
• Health history, signed & dated; update area
• Examination record
• Treatment plan
• Progress notes
• Parental or guardian consent Clinical examination

Patient Records
 • Should include:
• Developmental status and existing pathosis
• Record of each exam or procedure
• Facial and occlusal status
• Oral hygeine and periodontal status
• Prevention
• Charting system
• Primary and permanent dentition
•Developmental profile
• Family Dental History

CARIES RISK ASSESSMENT

• Fluoride History
• Dietary Habits
• Sleep time Habits
• Medications
• Nonnutritive sucking habits
• Family History
• Oral Hygiene Habits

FLUORIDE HISTORY

• Dosage
• Frequency
• Source
• Water
•Supplements

•Rinses

•Dentifrices
NEW PATIENT 1ST VISIT

• Complete Pediatric clinical chart

• Forming necessary radiographs
• Prophylactic fluoride application
• Patient & parent advices or education
• Diet analysis
• Assessment of child behavior
• Communication with the child
• Assessment of caries risk
• Instructions for home hygiene care

CLINICAL EXAMINATION

1. Visual Inspection – pain source is usually evident

2. Palpation – sensitivity over apex of tooth suggests periapical inflammation. Firm
or fluctuant swelling consistent with abscess
3. Percussion – pain/sensitivity consistent with periapical inflammation. Percussion of
each cusp helps locate incomplete fracture.
4. Mobility – check horizontal and vertical
5. Periodontal Probing – evaluate periodontal status. Aids in decision regarding retaining
or extracting
6. Thermal Sensitivity – tests pulpal status. Cold (ethyl chloride) is test of choice.
7. Normal / reversible pulpitis: not prolonged
8. Irreversible pulpitis: prolonged response
9. Necrotic pulp: no response – Heat test not usually done, difficult
Clinical Examination:

1. Comprehensive exam: clinical & radiographic

2. Systematic exam
3. General appraisal – Physical status – Behavioral assessment*
4. Head & Neck exam – Extraoral evaluation – Soft tissue evaluation*
5. Orthodontic evaluation
Extraoral Evaluation
1. Cranium – Inspect for sores, flaking, inflammation, swelling & symmetry
2. Neck – Thyroid gland-palpate/inspect for swelling – Musculature-inspect/palpate for
suppleness – Lymph nodes-palpate for lymphadenopathy
3. Hair – Inspect for thickness, color, dryness, consistency
4. Ears – Inspect for normal appearance, cartilaginous defects, pits and cutaneous lesions

AGE ONE DENTAL VISIT

• According to the American Academy of Pediatric Dentistry, a child's first checkup

should occur by 1 year of age
• At this important visit pedodontist will check the baby teeth for early cavities, show
you how to care for a young child's mouth properly, go over the child's developmental
milestones, and discuss the importance of good oral hygiene.

COMMON PEDIATRIC DENTAL PROCEDURES

• Stainless Steel Crowns (SSCs)

Stainless steel crowns are used to restore back teeth that are too badly decayed to hold
white fillings.
• When tooth decay on back teeth has been left untreated, teeth may have extensive
damage to the enamel, dentin and sometimes the nerve (pulp).
• In such cases, tooth-colored fillings are not a viable option, and stainless
steel crowns necessary.
• These prefabricated sliver-colored crowns are fit; then cemented onto the primary
(baby) teeth to prevent further damage until these teeth are naturally lost

Tooth Colored Fillings (Composite Resin)

 Tooth colored fillings are used to restore front or back teeth or where cosmetic appearance
is important.
• Composites are used to repair fractured teeth and/or areas of decay.
• The shade of the composite restorative material is matched as closely as possible to
the color of the natural teeth.

Dental Cleaning (Prophylaxis)

During a dental visit, the dental assistant or hygienist will first review the child’s medical
history
• .Then your child’s mouth will be examined for overall oral health.
• Next, the child’s teeth will be thoroughly cleaned to remove plaque and calculus
(hard tarter deposits), which can cause cavities and gum disease.
• After the cleaning, fluoride will be applied to the teeth to help protect and strengthen
the weak areas against decay.
• For a healthy child, the American Academy of Pediatric Dentistry recommends a visit
to the pediatric dentist at least every six months to evaluate the child’s oral health and
development.

Fluoride

Cavities form when there is a weakening in the mineral composition of the enamel of
your teeth.
• Fluoride promotes the remineralization of these decalcified spots, therefore helping to
prevent cavities.
• Low level of fluoride is found naturally in some bodies of water.
• Municipal water supplies are often fluoridated to a specific standard level.
• Fluoride can also be found in many household products such as toothpaste, mouth
rinses, and even some bottled water.
An excess of fluoride may damage developing teeth leading to fluorosis; while a deficit of
fluoride leaves your child’s teeth susceptible to tooth decay. Fluorosis presents in various
forms that affect developing permanent teeth by causing white spots to form.

Cavities (Caries)

• Tooth decay (caries) is a progressive disease that often begins in very

young children.
• Bacteria that normally live in the mouth react with sugars from foods and drinks to
create acid that slowly eats away at the enamel of the child’s teeth and can also damage
sensitive gum tissue.
• With the loss of enamel, weak points in the teeth form. These weak areas become
cavities– which left alone can lead to irreversible nerve damage and the necessary early
extraction of your child’s tooth.
• Again, early treatment is the key. As soon as a cavity is identified, dentist can repair
the tooth using tooth-colored fillings. If the cavity is too deep, a pulpotomy nerve
treatment and stainless steel crown or extraction of the tooth may be needed.
• Effective brushing and flossing, the proper use of fluoride, and a balanced diet can
help minimize the amount of decay to help child have a happy, cavity-free smile

Early (Interceptive) Orthodontic Care

It's never too early to keep an eye on the child's oral development.
• Dentist can identify malocclusion (crowded or crooked teeth) or bite problems and
actively intervene to guide the teeth as they emerge in the mouth.
• Interceptive orthodontic treatment can prevent more extensive treatment later. Dentist
checks the progress of your child’s bite and jaw development with routine dental
examinations.
• This early assessment of the child’s teeth may prevent extensive orthodontic work in
his/her future.
Extractions (Tooth Removal)

• Extractions are done only as a last resort in the case of severe tooth decay.
• If a primary molar is removed prematurely, a space maintainer will be placed.
• Some extractions are needed for orthodontic reasons to help facilitate tooth
alignment when crowded teeth are present.
• Primary teeth are essential in maintaining the correct spacing in the child’s jaw for the
permanent teeth.

Space Maintainers

• Space maintainers are used when a primary tooth has been prematurely lost (or
extracted) to hold space for the developing permanent tooth.
• If space is not maintained, teeth on either side of the extraction site can drift into the
space and prevent the permanent tooth from erupting into its proper position.
• The space maintainer will be removed from your child’s mouth once his/her
permanent tooth replacing the extracted tooth comes in.

Sealants
• Sealants are thin, white plastic coatings that are applied to the tops or
chewing surfaces of back teeth and are highly effective in preventing tooth decay.
• The naturally occurring pits and grooves on the chewing surfaces of teeth can often
collect plaque.
• These small grooves and cracks are the most susceptible to cavities in children and
teens and benefit the least from topical fluoride.
• Sealants and fluoride work together to help prevent tooth decay. On
average, sealants last for 5 to 10 years with proper maintenance. At every dental check-
up, the dentist will check that the sealants are intact.

Pulp Treatment (Pulpotomy)

 Pulp therapy (pulpotomy) is the treatment of infected nerves and blood vessels in teeth.
• Pulp therapy generally becomes necessary for two reasons: either as a result
of extensive tooth decay (dental cavities) or as the result of tooth injury.
• Failure to provide the necessary pulp therapy could result in the child experiencing
pain, infection, swelling, or loss of the tooth.
•

Many cavities may be so deep that they extend to the nerve, often causing pain and
discomfort.
• When this happens, the infected part of the nerve must be removed. The remaining
healthy nerve will be left intact and medicated. The purpose of a pulpotomy is to extend
the life of the baby tooth, thereby avoiding the need for extraction and a space maintainer,
until the eruption of the permanent tooth.
• In other words, the tooth can be preserved for chewing food and maintaining proper
space for permanent teeth, as well as helping the child to preserve a healthy, happy smile.

D0145
Oral evaluation for a patient under three years of age and counseling with
primary caregiver
• Diagnostic services performed for a child under the age of three, preferably within the
first six months of the eruption of the first primary tooth, including recording the oral and
physical health history,
• Evaluation of caries susceptibility, development of an appropriate preventive
oral health regimen
• Communication with and counseling of the child’s parent, legal guardian
and/or primary caregiver

Note: The goal of this evaluation is early intervention and the development of a prevention
plan for
pediatric patients under three years of age.
D0145
includes the following diagnostic services:

• Recording the oral and physical health history.

• Evaluation of caries susceptibility (risk assessment).

Consideration of developmental problems.
Consideration of the primary caregiver’s oral health.

• Development of an oral health regimen to reduce the child’s risk of caries.

• Counseling with the child’s primary caregiver:

Instructions for cleaning the child’s teeth.
Fluoride recommendations.
Diet recommendations.
Recommendations to reduce the transmission of bacteria (e.g., antibacterial
rinses, xylitol, etc.)

D0145 is not identified as either “comprehensive” or “periodic.”

• Therefore, D0145 may be reported for the initial oral evaluation and may be used for
subsequent oral evaluation visits, as long as the child remains under the age of three.
• Also, counseling must be provided at each visit, as the code specifically
requires counseling with the primary caregiver.
• Once the child reaches three years of age, periodic oral evaluation (D0120)
is typically reported.
• If the child is under three years of age at the time of the periodic oral evaluation and
counseling is not provided to the primary caregiver, consider reporting D0120.

D1120
prophylaxis – child

Removal of plaque, calculus and stains from the tooth structures in

the primary and transitional dentition.
It is intended to control local irritational
 Topical Fluoride Treatment (Office Procedure)

Prescription strength fluoride product designed solely for use in the dental office,
• Delivered to the dentition under the direct supervision of a dental professional.
• Fluoride must be applied seperately from prophylaxis paste

D1206-topical application of fluoride varnish

D1208-topical application of fluoride varnish-excluding varnish

 Space Maintenance (Passive Appliances)

Passive appliances are designed to prevent tooth movement

D1510
space maintainer - fixed, unilateral - per quadrant
Excludes a distal shoe space maintainer.

D1516
space maintainer fixed - bilateral, maxillary

D1517
space maintainer fixed - bilateral, mandibular
D1520
space maintainer - removable, unilateral - per quadrant

D1526
space maintainer - removable - bilateral, maxillary

D1527
space maintainer - removable - bilateral, mandibular

D1551
re-cement or re-bond bilateral space maintainer maxillary

D1552
re-cement or re-bond bilateral space maintainer mandibular

D1553
re-cement or re-bond unilateral space maintainer per quadrant

D1556
removal of fixed unilateral space maintainer per quadrant

D1557
removal of fixed bilateral space maintainer maxillary
Procedure performed by dentist or practice that did not originally place the appliance.

D1558
removal of fixed bilateral space maintainer mandibular
Procedure performed by dentist or practice that did not originally place the appliance.

D1575
distal shoe space maintainer - fixed, unilateral 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 follow-up or adjustments, or replacement appliances, once the
tooth has erupted

D1999
unspecified preventive procedure, by report Used for a procedure that is not adequately
described by a code.
Describe the procedure

Restorative Services

D2990
resin infiltration of incipient smooth surface lesions
Placement of an infiltrating resin restoration for strengthening, stabilizing
and/or limiting the progression of the lesion

D2929
prefabricated porcelain/ceramic crown - primary tooth

D2930
prefabricated stainless steel crown - primary tooth

D2931
prefabricated stainless steel crown permanent tooth

D2932
prefabricated resin crown

D2933
prefabricated stainless steel crown with resin window
Open-face stainless steel crown with aesthetic resin facing or veneer.
D2934
prefabricated esthetic coated stainless steel crown primary tooth
Stainless steel primary crown with exterior esthetic coating.

D2941
interim therapeutic restoration - primary dentition

Placement of an adhesive restorative material following caries debridement by hand or

other method for the management of early childhood caries. Not considered a definitive
restoration

D7111
Extraction, coronal remnants – deciduous tooth
Removal of soft tissue-retained coronal remnants.
D7111 reports the removal of a soft tissue retained coronal remnant of a primary tooth. If
the primary tooth is intact (i.e., the tooth crown plus some root), report D7140 for the
extraction.

D7111 is reimbursed at a lower rate than D7140.

Periodontics & Implantology

• Periodontics is the dental specialty focusing exclusively in the

inflammatory disease that destroys the gums and other supporting structures
around the teeth.
• A periodontist is a dentist who specializes in the prevention, diagnosis,
and treatment of periodontal, or disease, and in the placement of dental
implants.

• Periodontists treat cases ranging from mild gingivitis to more severe periodontitis.
• Periodontists offer a wide range of treatments,
• Scaling and root planing (the cleaning of infected root surfaces),
• Root surface debridement (the removal of damaged tissue),
• regenerative procedures (the reversal of lost bone and tissue).
• When necessary, periodontists can also perform surgical procedures for patients with
severe gum disease.
• Additionally, periodontists are trained in the placement, maintenance and repair of
dental implants.

List of procedures performed by a periodontist

 Non-Surgical Treatments
 Gum Graft Surgery
 Laser Treatment
 Regenerative Procedures
 Dental Crown Lengthening
 Dental Implants
 Pocket Reduction Procedures
 Plastic Surgery Procedures
Scaling and Root Planing
• This process is a precise cleaning of the root surfaces to eliminate plaque and tartar

• Scaling and root planing also combats bacterial toxins

• It is sometimes followed with adjunctive therapy like systemic antibiotics or host

modulation

• The majority of periodontists agree that many patients will not require additional
treatment following scaling and root planing yet ongoing maintenance therapy will be
necessary to sustain health

Treatment procedures

Regeneration

 Regeneration is a periodontal surgical procedure in which the periodontist folds

back gum tissue to eliminate bacteria. Everything from membranes to proteins that
stimulate tissue to bone grafts can be used to kick-start the body's inherent ability
to regenerate bone as well as tissue.

Soft Tissue Grafting

 This periodontic surgery requires the use of gum tissue outside of the area to be
treated. Gum tissue is taken from the palate or another source and used to cover
the root that is exposed. Soft tissue grafting can be performed on one or many teeth
to even the gum line and minimize sensitivity.
Gingivectomy

 Also known as gingival sculpting or crown lengthening, this is a periodontal

surgery in which extra tissue is eliminated under local anesthesia.

 The gums typically heal in about a week's time.

 The end result is a re-shaping of the unnecessary gum and bone tissue to expose the
natural tooth.

 This periodontics procedure also evens the gum line when applied to a single tooth.

 If performed on several teeth, it will provide a lovely broad smile.

The periodontium

 The term periodontium is used to describe the group of structures that directly
surround, support and protect the teeth.
 The periodontium is composed largely of the gingival tissue and the supporting
bone

Gingiva

 Normal gingiva may range in color from light coral pink to heavily pigmented.
 The soft tissues and connective fibres that cover and protect the underlying
cementum, periodontal ligament and alveolar bone are known as the gingivae.
 The gingivae are categorised into three anatomical groups;
 The free, attached and the interdental gingiva.
 Each of the gingival groups are considered biologically different; however, they are
 all specifically designed to help protect against mechanical and bacterial
destruction

Free gingiva
 The tissues that sit above the alveolar bone crest are considered the free gingiva
 In healthy periodontium, the gingival margin is the fibrous tissue that encompasses
the cemento-enamel junction, a line around the circumference of the tooth where
the enamel surface of the crown meets the outer cementum layer of the root.

Attached gingiva
 The junctional epithelium is a collar-like band that lies at the base of the gingival
sulcus and surround the tooth; it demarcates the areas of separation between the
free and attached gingiva

Interdental gingiva
 The interdental gingiva takes up the space beneath a tooth contact point, between
two adjacent teeth.

It is normally triangular or pyramidal in shape and is formed by two interdental
papillae (lingual and facial).
 The middle or centre part of the interdental papilla is made up of attached
gingiva, whereas the borders and tip are formed by the free gingiva.

Alveolar Mucosa

This area of tissue is non keratinized and is located beyond the mucogingival junction.

It is less firmly attached and is redder than attached gingiva.

It provides for the movement of cheek and lips.

Periodontal Ligament
 The periodontal ligament is the connective tissue that joins the outer layer of the
tooth root, being the cementum, to the surrounding alveolar bone.

It is composed of several complex fibre groups that run in different directions and
which insert into the cementum and bone via ‘Sharpey’s fibres’.

The periodontal ligament is composed mostly of collagen fibres, however it also
houses blood vessels and nerves within loose connective tissue.
Mechanical loads that are placed on the teeth during mastication and other external
forces are absorbed by the periodontal ligament, which therefore protects the teeth
within their socket

Alveolar Bone
 In periodontal health, the alveolar bone surrounds the teeth and forms the bony
socket that supports each tooth.

The buccal and lingual plates and lining of the sockets are composed of thin, yet
dense compact or cortical bone.
 Within the cortical plates and dental sockets lies cancellous bone, a spongy or
trabecular type bone which is less dense than compact bone.

Cementum
 Cementum is the outer layer of the tooth root; it overlies the dentine layer of the
tooth and provides attachment for the collagen fibres of the periodontal ligament.
 It also protects the dentine and provides a seal for the otherwise exposed ends of
the dentinal tubules.
 It is not as hard as enamel or dentine and is typically a light yellow colour

Classification of periodontal diseases

 I. Gingival Diseases
A. Dental plaque-induced gingival diseases
B. Non-plaque-induced gingival lesions

 II. Chronic Periodontitis

(slight: 1–2 mm CAL; moderate: 3–4 mm CAL; severe: > 5 mm CAL)
 A. Localised
B. Generalised (> 30% of sites are involved)

Classification of periodontal diseases

 III. Aggressive Periodontitis
(slight: 1–2 mm CAL; moderate: 3–4 mm CAL; severe: > 5 mm CAL)
 A. Localised
B. Generalised (> 30% of sites are involved)

 IV. Periodontitis as a Manifestation of Systemic Diseases

A. Associated with haematological disorders
B. Associated with genetic disorders
C. Not otherwise specified

 V. Necrotizing Periodontal Diseases

A. Necrotizing ulcerative gingivitis
B. Necrotizing ulcerative periodontitis

Classification of periodontal diseases

 VI. Abscesses of the Periodontium
A. Gingival abscess
B. Periodontal abscess
C. Pericoronal abscess

 VII. Periodontitis Associated With Endodontic Lesions

A. Combined periodontic-endodontic lesions

 VIII. Developmental or Acquired Deformities and Conditions

 A. Localised tooth-related factors that modify or predispose to plaque-induced
gingival diseases/periodontitis
 Mucogingival deformities and conditions around teeth

C. Mucogingival deformities and conditions on edentulous ridges

D. Occlusal trauma

Classification of periodontal diseases

Periodontitis:

Necrotizing Periodontal Diseases

Periodontitis
Periodontitis as a Manifestation of Systemic Disease

Other Conditions Affecting The Periodontium:

Systemic Diseases or conditions affecting the periodontal supporting tissues

Periodontal Abscesses and Endodontic-Periodontal Lesions
Mucogingival Deformities and Conditions
Traumatic Occlusal Forces
Tooth and Prosthesis Related Factors

Peri-Implant Diseases and Conditions:

Peri-Implant Health

Peri-Implant Mucositis

Peri-Implantitis

Peri-Implant Soft and Hard Tissue Deficiencies

Prevention

The most effective prevention method is what can be achieved by the patient at
home, for example, using the correct tooth brushing technique, interdental cleaning
aids such as interdental brushes or floss and using a fluoridated toothpaste.

It is also advised that patients receive bi annual check ups from their dental
health provider along with thorough cleaning.

Treatment

Along with specialist periodontist treatment, a general dentist or oral health

therapist/dental hygienist can perform routine scale and cleans using either hand
instruments or an ultrasonic scaler (or a combination of both).

 The practitioner can also prescribe specialised plaque removal techniques (tooth
brushing, interdental cleaning).

 The practitioner can also perform a plaque index to indicate to the patient areas of
plaque they are not removing on their own.

 This can be removed through the procedure of a dental prophylaxis

Aetiology

 The primary etiological factor for periodontal disease is plaque biofilm or dental
biofilm

 A dental biofilm is a community of microorganisms attached to a hard, non

shedding surfaces.

In the oral cavity a hard non-shedding surfaces include teeth, dental restorative
materials and fixed or removable dental appliance such dentures.[

 It is this adherence to non-shedding surface that allows bacteria in a dental biofilm

 to have unique characteristics of clinical significance.

Risk factors

 A risk factor is a variable that in health, can be defined as "a characteristic

associated with an increased rate of a subsequently occurring disease

Individual, modifiable risk factors include:

• Tobacco Smoking
• Alcohol consumption
• Diabetes Mellitus
• Obesity and Vitamin D Deficiency
• Cardiovascular disease

• Stress

Risk factors

 Non-modifiable risk factors include:

• Genetics and the Host response

• Drug induced disorders
• Haematological disorders
• Pregnancy

Treatment

Phases of Periodontal Therapy

 Contemporary periodontal treatment is designed based on the ‘Trimeric Model’,
and is performed in 4 phases.
 These phases are structured to ensure that periodontal therapy is conducted in a
logical sequence, consequently improving the prognosis of the patient, in
 comparison to indecisive treatment plan without a clear goal.

Treatment

Phase I Therapy (Initial Therapy - Disease Control Phase)

Non-surgical Phase

The non-surgical phase is the initial phase in the sequence of procedures required
for periodontal treatment.
 This phase aims to reduce and eliminate any gingival inflammation by
removing dental plaque, calculus (dental) restoration of tooth decay and
correction of defective restoration as these all contribute to gingival inflammation,
also known as gingivitis.
 Phase I consists of treatment of emergencies, antimicrobial therapy, diet control,
patient education and motivation, correction of iatrogenic factors, deep caries
hopeless teeth, preliminary scaling, temporary splinting, occlusal adjustment,
minor orthodontic tooth movement and debridement (dental)

Treatment

Re-evaluation Phase

During this phase, patients after 3–6 weeks from initial therapy; it is required to
re-evaluate the steps carried out after the phase I therapy.

 Usually 3–6 weeks re-evaluation is crucial in severe cases of periodontal disease.

The elements which are required to be re-evaluated are the results of initial
therapy (Phase I Therapy), oral hygiene and status, bleeding and plaque scores and
a review of diagnosis and prognosis and modification of the whole treatment plan if
necessary.
Treatment

Phase II Therapy (Surgical Phase)

After post Phase I, it is necessary to evaluate the requirement of periodontium for

surgery.

Factors identifying the Surgical phase is required are:

• Periodontal pocket management in specific situations,

• Irregular bony contours or deep craters,

• Areas of suspected incomplete removal of local deposits,

• Degree II and III furcation involvements,

• Distal areas of last molars with expected mucogingival junctionproblems,

• Persistent inflammation,

• Root coverage and removal of gingival enlargement

Treatment

Phase III Therapy (Restorative Phase)

 During this phase, any defects need to be restored with removable or fixed
through dental prosthesis, prosthodontics, or other restoration process.

Phase IV Therapy (Maintenance Phase)

 The last phase of Periodontal Therapy requires the preservation of periodontal
health.
 In this phase, patients are required to re-visit through a scheduled plan for
maintenance care to prevent any re-occurrence of the disease.
 The maintenance phase constitutes the long-term success for periodontal
treatment, thus contributes to a long relation between the oral health the
periodontist and the patient

Treatment

Periodontal and Restorative Interface

 The prognosis of the restorative treatment is determined by the periodontal health.

The goals for establishing periodontal health prior to restorative treatment are as
follows:
 Periodontal treatment should be managed to assure the establishment of
firm gingival margin prior to tooth preparation for restoration.
 Absence of bleeding tissue during restorative manipulation provides accessibility
and aesthetic outcome.
 Certain periodontal treatment is formulated to increase sufficient tooth length for
retention.
 Failure to accomplish these methods prior restorations can lead to the complexity
or risk of failure of treatment such as impression making, tooth preparation and
restoration.
 Periodontal therapy should follow restorative method as the resolution of gingival
inflammation may result in the repositioning of teeth or in soft tissue and mucosal
changes.
IMPLANTOLOGY

IMPLANTOLOGY, A BRANCH OF DENTISTRY FOCUSED ON DENTAL

IMPLANTS

A natural tooth has two main components:

 The Crown and the root. The crown is the visible part of the tooth and the root is
located below the gumline, in the bone of the jaw.
 Implantology is the branch of dentistry dedicated to dental implants.
 The dental implant is an artificial tooth root that is inserted into the jawbone
(either the maxilla or the mandible).
 It often takes the form of a screw that is composed of titanium or titanium alloy

IMPLANTS REPLACE MISSING TEETH

 Dental implants can be considered for patients who are missing one or more teeth
 A dental implant alone does not replace a natural tooth.
 An abutment must be mounted on the implant once the latter has been inserted into
the jawbone.
 Depending on the number of teeth to replace, an artificial crown, a full or partial
denture or a bridge will be prepared and installed on the abutment(s).
 If the patient only has one missing tooth, a single crown will be sufficient.

If several teeth need to be replaced, many options are available:

 Using a single implant with multiple crowns joined by a bridge or a prosthesis, or
 using multiple implants with distinct crowns.
 This choice is up to the patient, according to the treatment plan recommended by
the implantology specialist.

The most common types of dental implant materials

 Titanium dental implant materials

 Zirconia dental implant materials

TITANIUM, A BIOCOMPATIBLE MATERIAL

 Titanium is the best dental implant materials because it is biocompatible. This means
it is right and closely matched the human body. It can also fuse with the human bone.

AN OUTPATIENT PROCEDURE DONE UNDER LOCAL ANESTHESIA

 The insertion of dental implants is a surgical procedure that is usually performed

at the clinic and under local anesthesia.
 Several dental health professionals are qualified to install dental implants: dentists,
oral and maxillofacial surgeons, periodontists and other specialists in dentistry.
 Dentists and prosthodontists often specialize in the fabrication of crowns, bridges
and dentures that are mounted on the implants.
BENEFITS OF DENTAL IMPLANTS

 Implants allow the installation of fixed or removable dental prostheses.

 They are more comfortable and discreet because they do not cause any unpleasant
friction or movement on the gums as in the case of removable prostheses that are
not mounted on implants (e.g.: partial or complete dentures). It is possible to get an
implant-supported denture that does not even cover the palate at all.

 No adhesive (denture glue) is required to hold the implant-supported prosthesis in

place.

 Implants offer a better stability to artificial teeth, which facilitates chewing and
digestion, improves comfort and facilitates speech.

 The patients are not forced to adapt their diet.

BENEFITS OF DENTAL IMPLANTS

 Implants allow distributing chewing forces between implants and adjacent

structures of the mouth (gums, bones and remaining teeth), which helps to reduce
the stress on these structures
 When healthy teeth are still in the mouth, the patient can expect to be able to keep
these remaining teeth longer than if no implant was installed and if the space
created by missing teeth remained vacant
 Implants contribute to the preservation of the alveolar bone (the bone that
supports teeth) by preventing its resorption where teeth are missing
 When a tooth is missing, the alveolar bone that used to support it is not stimulated
 anymore and deteriorates gradually

BENEFITS OF DENTAL IMPLANTS

 Implants do not require grinding and modifying adjacent teeth (like in the case of a
traditional bridge)
 Implants give the impression of having natural teeth, both aesthetically and
functionally, and act as an artificial root anchored in the bone of the jaw, like a
natural tooth root
 The patients may, therefore, regain the integrity of their facial features that had
been affected by the loss of several teeth
 The two main components of an implant (the artificial crown and the implant
itself) will not be affected by tooth decay
PERIODONTICS & IMPLANTOLOGY CODES

Periodontal treatment

 Periodontal treatment has seen many changes over the last decade

 For example, different types of grafting material, both autogenous and non-
autogenous, are more common

 Dental implants many times are included in periodontal treatment planning

 Bone regeneration has become more predictable with the availability of new
products and techniques

 Periodontal procedure coding has grown with these changes as has the knowledge
base required to code correctly and obtain reimbursement for the treatment
completed

Site

The term site is use to describe a single area, or position

 “Site” is frequently used to describe an area of recession on a single tooth or an

osseous defect adjacent to a single tooth

 It can also apply to soft tissue or osseous defects in an edentulous area

For example:
 If two contiguous teeth have areas of recession, each area is a single site
 If two contiguous teeth have adjacent but separate osseous defects, each defect is a
single site
 If these defects communicate, however, they would be considered a single site
 In an edentulous area, up to two contiguous edentulous tooth positions may be
considered a single site
CDT CODES

D4230

anatomical crown exposure-four or more contiguous teeth or bounded tooth spaces

per quadrant
 This procedure is utilized in an otherwise periodontally healthy area to remove
enlarged gingival tissue and supporting bone (ostectomy) to provide anatomically
correct gingival relationship.

D4231

anatomical crown exposure-one to three teeth or bounded tooth spaces per

quadrant

 This procedure is utilized in an otherwise periodontally healthy area to remove

enlarged gingival tissue and supporting bone (ostectomy) to provide an
anatomically correct gingival relationship.

CDT CODES
 The changes better defines the area where the crown exposure is performed
 For example, even though a tooth #10 may be missing, if anatomical crown
lengthening is necessary on teeth #9 and #11, correct coding would be D4231 since
treatment would involve the edentulous area.
 Elevation of the flap to treat teeth #9 and #11 would require some revision of the
tissue where tooth #10.
 Thus, the correct description includes a bounded tooth space.
CDT CODES

D4210

gingivectomy or gingivoplasty - four or more

 contiguous teeth or tooth bounded spaces per quadrant
 It is performed to eliminate suprabony pockets or to restore
 normal architecture when gingival enlargements or
 asymmetrical or unaesthetic topography is evident with normal bony
configuration.

D4211

gingivectomy or gingivoplasty - one to three

 contiguous teeth or tooth bounded spaces per quadrant
 It is performed to eliminate suprabony pockets or to restore
 normal architecture when gingival enlargements or
 asymmetrical or unaesthetic topography is evident with normal bony
configuration.

D4212

gingivectomy or gingivoplasty to allow access for

 restorative procedure, per tooth

Tips
 It is especially important in the periodontal category to realize that procedure
codes are meant to describe the treatment rendered, NOT the means that are used
to accomplish the treatment
 For example, a gingivectomy can be done by several techniques, including utilizing
a blade, a periodontal knife or a laser. The code for the procedure, however, is the
same.
 With attention to detail and a basic understanding of periodontal treatment and
 codes, a dental office can prevent confusion for the patient and misunderstanding
of plan coverage while at the same time obtain reimbursement as effectively and
efficiently as possible

D4346

scaling in presence of generalized moderate or severe gingival inflammation – full

mouth, after oral evaluation
 The removal of plaque, calculus and stains from supra- and sub-gingival tooth
surfaces when
 There is generalized moderate or severe gingival inflammation in the absence of
periodontitis.
 It is indicated for patients who have swollen, inflamed gingiva, generalized
suprabony pockets,
 And moderate to severe bleeding on probing. Should not be reported in
conjunction with
 Prophylaxis, scaling and root planing, or debridement procedures.

Loss of attachment

 “Damage to the structures that support the tooth; results from periodontitis and is
characterized by relocation of the junctional epithelium to the tooth root,
destruction of the fibers of the gingiva, destruction of the periodontal ligament
fibers, and loss of alveolar bone support from around the tooth.”

 Loss of attachment results from loss of bone

 D4355

Full mouth debridement to enable a comprehensive evaluation and diagnosis on

a subsequent visit
 Full mouth debridement involves the preliminary removal of plaque and calculus
that interferes with the
 Ability of the dentist to perform a comprehensive oral evaluation.
 Not to be completed on the same day as D0150, D0160 or D0170
 This code may be used prior to and on a different date than
a D4341, D4342, D1110, and any evaluation code.

 Note the generalized nature of deposits. Periodontal probing and charting may be
difficult in such a case, and debridement could facilitate the comprehensive oral
evaluation.
 D1110

prophylaxis – adult

Removal of plaque, calculus and stains from the tooth structures in the
permanent and transitional dentition.
 It is intended to control local irritational factors.

D1120

prophylaxis – child
 Removal of plaque, calculus and stains from the tooth structures in the primary
and transitional dentition.
 It is intended to control local irritational factors.

D4381

Localized Delivery of Chemotherapeutic Agents

 This code is designed to describe any crevicular agent used to treat periodontal
disease
 Many carriers do not cover this procedure as a matter of contract
 A few will pay a benefit when it is done in refractory areas following root planing
and/or surgery
 Typically a time lapse between the active therapy and the crevicular treatment is
required, often at least four to six weeks
 The claim form should include case type (usually at least Type III–Moderate
Periodontitis), progressive periodontal probing, a narrative stating that the patient
has previously undergone treatment and the dates of that treatment, and the
pockets being treated
 D4341

periodontal scaling and root planing – four or more teeth per quadrant

 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.
 Root planing is the definitive procedure designed for the removal of cementum and
dentin that is rough, and/or permeated by calculus or contaminated with toxins or
microorganisms.
 Some soft tissue removal occurs.
 This procedure may be used as a definitive treatment in some stages of periodontal
disease and/or as a part of pre-surgical procedures in others.

D4342

periodontal scaling and root planing – one to three teeth per quadrant

 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.

 Root planing is the definitive procedure designed for the removal of cementum and
dentin that is rough, and/or permeated by calculus or contaminated with toxins or
microorganisms.

 Some soft tissue removal occurs.

 This procedure may be used as a definitive treatment in some stages of periodontal

disease and/or as a part of pre-surgical procedures in others.
 D4910

periodontal maintenance
 This procedure is instituted following periodontal therapy and continues at varying
intervals, determined by the clinical evaluation of the dentist, for the life of the
dentition or any implant replacements.
 It includes removal of the bacterial plaque and calculus from supragingival and
subgingival regions, site specific scaling and root planing where indicated, and
polishing the teeth.
 If new or recurring periodontal disease appears, additional diagnostic and treatment
procedures must be considered.

D4240

gingival flap procedure, including root planing -four or more contiguous teeth or
tooth bounded spaces per quadrant

 A soft tissue flap is reflected or resected to allow debridement of the root surface
and the removal of granulation tissue.
 Osseous recontouring is not accomplished in conjunction with this procedure.
 May include open flap curettage, reverse bevel flap surgery, modified Kirkland
flap procedure, and modified Widman surgery.
 This procedure is performed in the presence of moderate to deep probing depths,
loss of attachment, need to maintain esthetics, need for increased access to the root
surface and alveolar bone, or to determine the presence of a cracked tooth,
fractured root, or external root resorption.
 Other procedures may be required concurrent to D4240 and should be reported
separately using their own unique codes
 D4241

gingival flap procedure, including root planing -one to three contiguous teeth or
tooth bounded spaces per quadrant

D4245

apically positioned flap

Procedure is used to preserve keratinized gingiva in conjunction with osseous

resection and second stage implant procedure. Procedure may also be used to
preserve keratinized/attached gingiva during surgical exposure of labially
impacted teeth, and may be used during treatment of peri-implantitis.

D4260

Osseous surgery (including elevation of a full thickness flap and closure) – four or
more contiguous teeth or tooth bounded spaces per quadrant

This procedure modifies the bony support of the teeth by reshaping the alveolar
process to achieve a more physiologic form during the surgical procedure.

This must include the removal of supporting bone (ostectomy) and/or non-
supporting bone (osteoplasty). Other procedures may be required concurrent to

D4260 and should be reported using their own unique codes.

D4261
 osseous surgery (including elevation of a full thickness flap and closure) – one to
three contiguous teeth or tooth bounded spaces per quadrant
 D4263

bone replacement graft – retained natural tooth –first site in quadrant

D4264

bone replacement graft – retained natural tooth –each additional site in quadrant

D4265

biologic materials to aid in soft and osseous tissue regeneration

D1330

oral hygiene instructions

D9311

consultation with a medical health care professional

D0171

re-evaluation- post operative office visit

D9630

drugs or medicaments dispensed in the office for home use

D4999

unspecified periodontal procedure, by report:

 This code may apply when a provider feels there is no specific code for the
procedure completed.
 In these cases, a narrative or report is necessary to explain the unusual
circumstance.
 IMPLANTOLOGY

PRE-SURGICAL SERVICES

D6190

 Radiographic/surgical implant index, by report

SURGICAL SERVICES

D6010

Surgical placement of implant body: endosteal implant

D6011

Second stage implant surgery

D6012

Surgical placement of interim implant body for transitional prosthesis: endosteal

implant

D6013

Surgical placement of mini implant

D6040

Surgical placement: eposteal implant

 D6050

Surgical placement: transosteal implant

D6100

Implant removal, by report

D6101

Debridement of a peri-implant defect or defects surrounding a single implant, and

surface cleaning of the exposed implant surfaces, including flap entry and closure

D6102

Debridement and osseous contouring of a peri-implant defect or defects

surrounging a single implant and includes surface cleaning of the exposed implant
surfaces, including flap entry and closure

D6103

Bone graft for repair of peri-implant defect – does not include flap entry and
closure

D6104

Bone graft at time of implant placement

IMPLANT SUPPORTED PROSTHETICS

Supporting Structures

D6055

Connecting bar – implant supported or abutment supported

D6056

Prefabricated abutment – includes modification and placement

 D6057

Custom fabricated abutment – includes placement

D6051

Interim abutment

D6052

Semi-precision attachment abutment

CDT CODES

Implant/abutment supported removable dentures

D6110

Implant/abutment supported removable denture for edentulous arch – maxillary

D6111

Implant/abutment supported removable denture for edentulous arch - mandibular

D6112

Implant/abutment supported removable denture for partially edentulous arch –

maxillary

D6113

Implant/abutment supported removable denture for partially edentulous arch -

mandibular

CDT CODES

Implant/abutment supported fixed dentures (hybrid)

D6114
Implant/abutment supported fixed denture for edentulous arch - maxillary

D6115

Implant/abutment supported fixed denture for edentulous arch – mandibular

D6116

Implant/abutment supported fixed denture for partially edentulous arch -

maxillary

D6117

Implant/abutment supported fixed denture for partially edentulous arch -

mandibular

Single Crowns, Implant Supported

D6065

Implant supported porcelain/ceramic crown

D6066

Implant supported porcelain fused to metal crown (titanium, titanium alloy, high
noble metal)

D6067

Implant supported metal crown (titanium, titanium alloy, high noble metal)
Fixed Partial Denture, Implant Supported

D6075

Implant supported retainer for ceramic FPD

D6076

Implant supported retainer for porcelain fused to metal FPD (titanium, titanium
alloy, or high noble metal)

D6077

Implant supported retainer for cast metal FPD (titanium, titanium alloy, or high
noble metal)

OTHER IMPLANT SERVICES

D6080

Implant maintenance procedures when prostheses are removed and reinserted,

including cleansing of prostheses and abutments

D6081

Scaling and debridement in the presence of inflammation or mucositis of a single

implant, including cleaning of the implant surfaces, without flap entry and closure

D6085

Provisional implant crown

D6090
Repair implant supported prosthesis, by report

D6095

Repair implant abutment, by report D6091 Replacement of semi-precision or

precision attachment (male or female component) of implant/abutment supported
prosthesis, per attachment
ORAL PATHOLOGY

• Oral pathology is the dental specialty that studies the causes and effects of diseases
affecting the mouth and surrounding structures,
• According to the American Academy of Oral and Maxillofacial Pathology, These
diseases can involve the teeth, the supporting bones and the temporomandibular joints, as
well as the gums, tongue and other soft tissues, like the salivary glands.
• While tooth decay and gum disease may be the most familiar oral issues, there are a
number of other conditions that can affect the mouth.
• In most cases, these conditions can be treated by a dentist or prevented by practicing a
thorough oral care routine.

DIAGNOSIS

The key to any diagnosis is

•thorough medical, dental, social and psychological history as well as assessing
certain lifestyle risk factors that may be involved in disease processes
•followed by a thorough clinical investigation including extra-oral and intra-oral
hard and soft tissues.
• It is sometimes the case that a diagnosis and treatment regime are possible
to determine from history and examination, however it is good practice to compile a list
of differential diagnoses. Differential diagnosis allows for decisions on what further
investigations are needed in each case.
• There are many types of investigations in diagnosis of oral and
maxillofacial diseases,including screening tests,
imaging (radiographs, CBCT, CT, MRI, ultrasound and histopathology (biopsy)

GROSS EXAMINATION

• Gross examination or "grossing" is the process by which pathology specimens are

inspected with the bare eye to obtain diagnostic information, while being processed
for further microscopic examination
 • Gross examination of surgical specimens is typically performed
by a pathologist working within a pathology practice
• Individuals trained in these fields are often able to gather diagnostically critical
information in this stage of processing, including the stage and margin status of surgically
removed tumors

BIOPSY

A biopsy is a surgical procedure that involves the removal of a piece of tissue sample from
the living organism for the purpose of microscopic examination
•

Types of biopsies typically used for diagnosing oral and maxillofacial pathology are:

Excisional biopsy:
A small lesion is totally excised
This method is preferred, if the lesions are approximately 1 cm or less in diameter, clinically
and seemingly benign and surgically accessible
Large lesions which are more diffused and dispersed in nature or those which are seemed to
be more clinically malignant are not conducive to total removal

Incisional biopsy:
• A small portion of the tissue is removed from an abnormal-looking area
for examination. This method is useful in dealing with large lesions. If the
abnormal region is easily accessed, the sample may be taken at your doctor's office. If
the tumor is deeper inside the mouth or throat, the biopsy may need to be performed in an
operating room. General anesthesia is administered to eliminate any pain.

Exfoliative cytology:
• A suspected area is gently scraped to collect a sample of cells for examination. These
cells are placed on a glass slide and stained with dye, so that they can be viewed under a
microscope. If any cells appear abnormal, a deeper biopsy will be performed.
 MICROORGANISMS

• Microorganisms (or microbes) are organisms which can only be individually seen by
microscopy. Many do not cause disease in humans and act as normal colonizers of human
hosts. Complex interactions between pathogens, which are capable of causing diseases,
the host and the environment lead to clinical infections.

Pathogens fall into five main groups:

• Viruses
• Bacteria
• Fungi
• Protozoa
• Helminths.

STAINING

• Staining is a technique used to enhance contrast in samples, generally

at the microscopic level.
• Stains and dyes are frequently used in histology (the study of tissue under
the microscope) and in the medical fields
of histopathology, hematology and cytopathology that focus on the study
and diagnoses of disease at a microscopic level.
• Stains may be used to define biological tissues (highlighting, for
example, muscle fibers or connective tissue), cell populations (classifying different blood
cells), or organelles within individual cells.

DIFFERENTIAL STAINING TECHNIQUES

 • Gram Stain
• Acid Fast Stain
• Endospore Stain
• Ziehl-Neelsen stain
• Haematoxylin and eosin (H&E) staining
• Papanicolaou staining
• PAS staining
• Masson's trichrome
• Romanowsky stains
• Silver staining
• Sudan staining
• Wirtz-Conklin staining
• Collagen Hybridizing Peptide Staining

Immunoflouroscence

IMMUNOHISTOCHEMISTRY
Immunohistochemistry (IHC) is a method for detecting antigens orhaptens in cells of a tissue
section by exploiting the principle of antibodies binding specifically to antigens in biological
tissues.

The antibody-antigen binding can be visualized in different manners.

Immunoflouroscence

Immunofluorescence of human skin using an anti-IgA antibody. : IgA depositsare found in the walls
of small superficialcapillaries (yellow arrows).The pale wavy green area on top is the epidermis, the
bottom fibrous area is the dermis

Electron Microscopy
An electron microscope is a microscope that uses a beam of accelerated electrons as a
source of illumination. As the wavelength of an electron can be up to 100,000 times shorter
than that of visible light photons,electron microscopes have a higher resolving power than light
microscopes and can reveal the structure of smaller objects.

Diseases

◾ Oral and maxillofacial pathology can involve many different types oftissues of the
head.

◾ Different disease processes affectdifferent tissues within this regionwith various

outcomes.

A great many diseases involve the mouth,jaws and orofacial skin. Some examples of oral abnormalities
and diseases are:

◾ Cleft palate or cleft lip

◾ Jaw misalignment

◾ Macroglossia (tongue enlargement)

◾ Periodontal disease

◾ Oral ulcers
 ◾ Geographic tongue

◾ Oral cancer

SYMPTOMS OF ORAL CANCER

Some of the common symptoms of oral cancer include:

◾ Chronic throat soreness or hoarseness

◾ Sores or lesions inside the mouth

◾ Red or white patches on the interior cheeks or tongue

◾ Excessive bleeding of mouth sores

WHAT CONDITIONS DOES AN ORAL PATHOLOGISTTREAT?

◾ Tooth decay and cavities are among the most common oral issues, butthey are not
the only conditions that can affect the mouth and surrounding structures.

◾ Oral pathology is a wide-ranging dental specialty that includes a widerange of

abnormalities and diseases.

◾ An oral pathologist is therefore concerned not so much with the teethas with
diagnosis, treatment, and study of disorders of the mouth, jaw, and soft tissues.

Oral cancer:

◾ Oral cancer is one of the most serious conditions that an oral pathologist may treat

◾ Can occur at the lips and throat in addition to the mouth and tongue.

◾ Like other types of cancers, oral cancer can spread, and early detection is
often the key tosuccessful treatment.

◾ It may be a dentist or doctor that first notices signs of malignancy in the mouth
 during an oralcancer screening or routine examination.

◾ Should see a dentist or doctor right away if notice symptoms such as unusual
lumps or soresin the mouth, white or red patches on the tongue or interior of the
cheeks, or chronic hoarseness of your voice or soreness of your throat.

◾ Once a diagnosis has been made, dentist may refer you to an oral pathologist for
treatment.

◾ The good news is that oral cancer is largely preventable. Heavy alcohol
consumption and/or smoking are the primary contributing factors. These
behaviors can be brought under control.

Macroglossia

◾ Macroglossia is the scientific name for an enlarged tongue.

◾ Sometimes it is hereditary or the result of an inherited condition, such as

Down syndrome oracromegaly.

◾ If this is the case, macroglossia may be present from birth. It can also occur later in life as
a result of trauma, certain cancers, or acquired conditions like hypothyroidism.

◾ Macroglossia can vary in severity.

◾ Mild cases may require only minimal treatment.

◾ Rather than trying to correct the tongue enlargement, the patient may require only speech
therapy.

◾ Treatment for macroglossia depends partly on what is causing it.

◾ Treating an underlying condition like hypothyroidism may cause the tongue to

reduce in size on itsown. Otherwise, it is sometimes necessary to perform
surgery to correct problems with chewing, feeding, and speech that can arise from
macroglossia.

Mouth Ulcers

◾ Mouth ulcers are also known as canker sores

◾ They are small, painful lesions that can develop at several locations inside the mouth

◾ Canker sores can be confused with cold sores (caused by the herpes simplex
virus) or oralcancer

◾ However, mouth ulcers are not caused by a virus, like cold sores, nor are they
malignant likeoral [Link] cause of canker sores is not known

◾ Though annoying, most mouth ulcers are harmless and resolve within a couple of
weeks

◾ However, some canker sores are major, meaning that they take longer to
resolve and maycause scar tissue

◾ If mouth ulcers are causing you problems that interfere with life activities,
you may need tosee an oral pathologist about possible treatment options and
to rule out oral cancer
ORAL PATHOLOGY CODES

TESTS AND EXAMINATIONS

D0411 HbA1C in-office point of service testing

D0412 blood glucose level test -in-office using a his glucose meter procedure provides an
immediate finding of a patient's blood glucose

D0415 collection of microorganisms for culture and sensitivity

D0416 viral culture A diagnostic test to identify viral organisms, most often herpes virus.

D0417 collection and preparation of saliva sample for laboratory diagnostic testing

D0418 analysis of saliva sample Chemical or biological analysis of saliva sample for
diagnostic purposes.

D0419 assessment of salivary flow by measurement This procedure is for identification of

low salivary flow in patients at risk for hyposalivation and xerostomia, as well as
effectiveness of pharmacological agents used to stimulate saliva production.

D0422 collection and preparation of genetic sample material for laboratory analysis and
report
D0423 genetic test for susceptibility to diseases -specimen analysis Certified laboratory
analysis to detect specific genetic variations associated with increased susceptibility for
diseases.

D0425 caries susceptibility tests. Not to be used for carious dentin staining.

D0431 adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities

including premalignant and malignant lesions,not to include biopsy or cytology procedures

DO601 caries risk assessment and documentation, with a finding of low risk Using
recognized assessment tools. DO602 caries risk assessment and documentation, with a
finding of moderate risk Using recognized assessment tools.

DO603 caries risk assessment and documentation, with a finding of high risk Using
recognized assessment tools.

ORAL PATHOLOGY LABORATORY

These procedures do not include collection of the tissue sample, which is documented
separately.

D0472 accession of tissue, gross examination, preparation and transmission of written report
To be used in reporting architecturally intact tissue obtained by invasive means.

D0473 accession of tissue, gross and microscopic examination, preparation and transmission
of written report To be used in reporting architecturally intact tissue obtained by invasive
means.

D0474 accession of tissue, gross and microscopic examination,including assessment of

surgical margins for presence of disease, preparation and transmission of written report To be
used in reporting architecturally intact tissue obtained by invasive means

DO480 accession of exfoliative cytologic smears, microscopic examination, preparation and

transmission of written report To be used in reporting disaggregated, non-transepithelial cell
cytology sample via mild scraping of the oral mucosa.
D0486 laboratory accession of transepithelial cytologic sample,microscopicexamination,
preparation and transmission of written report Analysis, and written report of findings, of
cytological sample of disaggregated transepithelial cells.

D0475 decalcification procedure Procedure in which hard tissue is processed in order to

allow sectioning and subsequent microscopic examination.

D0476 special stains for microorganisms Procedure in which additional stains are applied to
biopsy or surgical specimen in order to identify microorganisms.

D0477 special stains, not for microorganisms Procedure in which additional stains are
applied to a biopsy or surgical specimen in order to identify such things as melanin, mucin,
iron, glycogen, etc.

D0478 immunohistochemicalstains A procedure in which specific antibody based reagents

are applied to tissue samples in order to facilitate diagnosis.

D0479 tissue in-situ hybridization, including interpretation A procedure which allows for the
identification of nucleic acids, DNA and RNA, in the tissue sample in order to aid in the
diagnosis of microorganisms and tumors.

D0481 electron microscopy

D0482 direct immunofluorescence A technique used to identify immunoreactants which are

localized to the patient's skin or mucous membranes.

D0483 indirect immunofluorescence A technique used to identify circulating

immunoreactants.

D0484 consultation on slides prepared elsewhere A service provided in which microscopic

slides of a biopsy specimen prepared at another laboratory are evaluated to aid in the
diagnosis of a difficult case or to offer a consultative opinion at the patient's request. The
findings are delivered by written report.

D0485 consultation, including preparation of slides from biopsy material supplied by

referring source A service that requires the consulting pathologist to prepare the slides as well
as render a written report. The slides are evaluated to aid in the diagnosis of a difficult case or
to offer a consultative opinion at the patient's request.
DO502 other oral pathology procedures, by report

DO999 unspecified diagnostic procedure, by report Used for a procedure that is not
adequately described bya code. Describe the procedure.

PUBLIC HEALTH DENTISTRY

Dental Public Health

▪ Dental Public Health (DPH) is a non-clinical specialty of dentistry

that deals with the prevention of oral disease and promotion of
oral health.
▪ Dental public health is involved in the assessment of key dental health
needs and coming up with effective solutions to improve the dental
health of populations rather than individuals
• Prevention is becoming increasingly important.
• Dental related diseases are largely preventable and there is a growing burden
on health care systems for cure.
• Dental public health looks beyond the role of a dental practitioner in
treating dental disease, and seeks to reduce demand on health care systems by
redirection of resources to priority areas.
• Countries around the world all face similar issues in relation to dental disease.
• Implementation of policies and principles vary due to available of resources. Similar
to public health, an understanding of the many factors that influence health will assist
the implementation of effective strategies
• Public health dentistry, is practiced generally through government
sponsored programs, which are for the most part directed toward public-school
children in the belief that their education in oral hygiene is the best way to reach
the general public.
 • The pattern for such programs in the past was a dental practitioners annual visit to a
school to lecture and to demonstrate proper tooth-brushing techniques.
• The 1970s saw the emergence of a more elaborate program that included a week of
one-hour sessions of instruction, demonstration, and questions and
answers, conducted by a dentist and a dental assistant and aided by a teacher who
had previously been given several hours of instruction.
• Use was also made of televised dental health education programs, which parents were
encouraged to observe.
Competencies

• The American Board of Dental Public Health (ABDPH) have devised a list

of competencies for dental public health specialists to follow.[

• Dental public health specialists are a select group of certified dentists.
• The 10 competencies allow for growth and learning of individuals and
set expectations for the future.
• An advantage of the design is that they are implementable on a global level.

The list is updated periodically

1. Manage oral health programs for population health
2. Demonstrate ethical decision-making in the practice of dental public health
3. Evaluate systems of care that impact oral health
4. Design surveillance systems to measure oral health status and its determinants
5. Communicate on oral and public health issues
6. Lead collaborations on oral and public health issues
7. Advocate for public health policy, legislation, and regulations to protect
and promote the public's oral health, and overall health
8. Critically appraise evidence to address oral health issues for individuals
and populations
9. Conduct research to address oral and public health problems
10. . Integrate the social determinants of health into dental health practice

Criteria to determine a public health problem

 • To allow a health problem to be properly managed, it is important that there
is a set of rules or criteria to follow which determines what is defined as a public
health problem and what is the best way to manage health problems in
communities.
• The following are questions should be considered when addressing public
health problems:
•

What is the prevalence of the condition?

1. What is the prevalence of the health problem?
2. Is the disease widespread?
3. Who has the disease?
4. What percentage of the population is affected?
5. What is the distribution of the disease within the community?
6. Is the prevalence increasing or decreasing?

What is the impact of the condition on an individual level?

1. How severe are the effects of the disease on the patient?
2. Do people die because of it?
3. Do they suffer pain, discomfort or loss of function?
4. Can they perform their normal social roles?
5. Are they prevented from going to school or becoming employed because of
their problem?

What is the impact on the wider society?

1. What are the costs to the health service of treating the condition?
2. How much time do people take off work to get treatment and care?
3. What effects does the condition have on economic performance and
productivity of the country?

What conditions are preventable and effective treatments available?

 1. Is the natural history of the disease fully understood?
2. Can the early stages of the conditions be recognised?
3. If so, are there interventions that can be implemented to stop the
disease progressing?
4. If it does progress, are there effective treatments available?

Approaches to prevention

Fluoridation of drinking water

• Water fluoridation is the implementation of artificial fluoride in public
water supplies with the intentions to halt the progression of dental diseases.
• Fluoride has the ability to interfere with
the demineralisation and remineralisation process that occurs on the tooth surface
and improves the mineral intake when the pH level may reduce below the neutral
pH level.
• This achievement was implemented through the public health development in
the 19th, 20th century and led into the 21st century.
• Research into the effects of fluoride on teeth began due to the concern about
the presence of dental fluorosis

Determinants of oral health

Oral health promotion focuses on individual behaviour,

the Socioeconomic statusand environmental factors.
Underlying determinants that can also impact oral health, including non-milk extrinsic
sugars consumption, alcohol consumption and smoking behaviour.
 The ability to remove dental plaque, exposure to fluoride and access to quality dental care
can affect the ways the aforementioned underlying factors are and can be modified to the
needs of the individual to obtain optimum oral health.
Ways in which oral health promotion can minimise the effects of these determinants;

• Promoting healthy eating.

• Teaching effective oral hygiene practices.
• Promoting the use of topical fluoride for preventing and control
of dental caries
• Facilitating early access to preventative dental services
•

It is also important to note that these factors are also influenced by socio-
political considerations that are outside the control of most individuals.[
Community participation is a key factor in oral health promotion. Inter-
sectoral collaboration is where relevant agencies and sectors are involved in partnership
to identify key oral health issues and to implement new methods to improve oral health.

Research studies on dental public health issues

• Oral health in care homes

•

• School dental screening programs

•

• One-to-one oral hygiene advice provided in a dental setting for oral health
•

• Community based population level interventions for promoting child oral

health
 THE ADA STANDARDS ADMINISTRATION

AMERICAL DENTAL ASSOSIATION(ADA)

• ANSI –AMERICAN NATIONAL STANDARDS INSTITUTE

• The ADA is an ANSI accredited standards developing organization, and also designated
the official United States representative for the International Organization for
Standardization (ISO) Technical Committee 106 Dentistry (TC 106).

• Thus they are designated as ANSI/ADA Standards

• The ADA is also the sponsor and secretariat of the United States Technical Advisory
Group to ISO Technical Committee 106 Dentistry

• The ADA is the voice of American dentistry around the world

DENTAL STANDARDS

• Dental standards ensure that those who design and manufacture dental products and the
dentists who use them are on the same page
• ADA establishes baseline standards and technical recommendations for almost every tool
of modern dentistry, from radiographic systems to sealants to manual toothbrushes

• MISSION

• To ensure the highest level of patient safety , through the publication of clear industry
standards for both dental products and dental informatics

• Professional satisfaction

STANDARDS AND STANDARDS ADMINISTRATION

• The ADA Standards Administration Department (DSA) manages two consensus bodies
for standards development:

• The ADA Standards Committee on Dental Informatics (SCDI)

• The ADA Standards Committee on Dental Products (SCDP)

DENTAL INFORMATICS

• The goal of the ADA Standards Committee on Dental Informatics :

• To help dentists streamline and empower their practices using information technology

• The SCDI develops standards for choosing the hardware, software and digital imaging
solutions to create a fully computerized practice.

DENTAL PRODUCTS

• Before the purchase of new equipment, instruments or materials for the dental practice,
consult the latest standards and reports issued by the ADA Standards Committee on
Dental Products (SCDP)
• Volunteers work to produce detailed standards for almost every professional and public
oral health product

• These standards help to ensure the health and safety of both the dental patient and dental
professional by setting the requirements that will deliver consistent quality and
effectiveness

INTERNATIONAL STANDARDS

With the expansion of the global market in dental products and supplies, it’s crucial to have
reliable international standards that ensure compliance and safety across borders

PURCHASE ANSI/ADA STANDARDS

• Available online - All ANSI/ADA Standards, Technical Reports and Technical

Specifications for Dental Products and Informatics

• Each standard is written by the dental profession for the dental profession and illustrates
the ADA’s leadership in standards for safe and effective oral healthcare

• All standards may be securely purchased and electronically downloaded for instant access
or may be purchased in hard copy format and mailed