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Dental Services: CDT Codes - UHCprovider.com

Dental Services: CDT Codes Page 1 of 21 UnitedHealthcare Medicare Advantage Policy Appendix: Applicable Code List Approval 12/08/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc. UnitedHealthcare Medicare Advantage Policy Appendix: Applica ble Code List Dental Services: CDT Codes This list of Codes applies to the Medicare Advantage Policy Guideline titled Dental Services. Approval Date: December 8, 2021 Applicable Codes The following list(s) of procedure and/or diagnosis Codes is provided for reference purposes only and may not be all inclusive.

D0220 . Intraoral-periapical first radiographic image : D0230 . Intraoral-periapical each addition radiographic image : D0310 . Sialography : D0320 . Temporomandibular Joint Arthrogram, including injection

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