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DENTAL FEE SCHEDULE

DENTAL FEE SCHEDULE Diagnostics Code Description CCN Region 1 CCN Region 2 CCN Region 3 D0120 Periodic oral evaluation established patient D0140 Limited oral evaluation problem focused D0150 Comprehensive oral evaluation new or established patient D0160 Detailed and extensive oral evaluation problem focused, by report D0170 Re-evaluation limited, problem focused (established patient; not post-operative visit) D0171 Re-evaluation post-operative office visit D0180 Comprehensive periodontal evaluation new or established patient D0190 Screening of a patient D0191 Assessment of a patient D0391 Interpr of diagnostic image by prac not associated with capture of the image, incl report D0393 Treatment simulation using 3D image volume D0394 Digital subtraction of two or more images or image volumes of the same modality D0395 Fusion of two or more 3D image volumes of one or more modalities D0411 HbA1c in-office point of service testing D0412 Blood glucose level test in-office using a glucose meter D0414 Processing microbial specimen incl C&S.

Jun 01, 2020 · D0601 Caries risk assessment and documentation, with a finding of low risk 60.09 60.09 60.09 D0602 Caries risk assessment and documentation, with a finding of moderate risk 60.09 60.09 60.09 D0603 Caries risk assessment and documentation, with a finding of high risk 60.09 60.09 60.09 D0999 Unspecified diagnostic procedure, by report 145.65

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