bone - Aetna Dental

1 Current Den tal Termin olo gy American De nt al A sso ciatio n. A ll rig h ts re s erv ed. 01/01/2018 Medical in Nature Oral S urg ery Effective 01/01/2018 CDT Code Description (CDT code) CPT Code Description (CPT Code) Requires Precert / Review by OMFS PM D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth 21140 Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure) D7285 Biopsy of oral tissue (hard) 20220 20240 20245 Biopsy, m us cl e; superficial Biopsy, bone, excisional.

2 Superficial Biopsy, bone, excisional; deep D7286 Biopsy of oral tissue (s oft) 20200 20205 40490 40808 41100 41105 41108 42100 42800 Biopsy, m us cl e; superficial Biopsy, muscle; deep Biopsy of lip Biopsy, vestibule of mouth Biopsy of tongue, anterior two-thirds Biopsy of tongue, posterior one-third Biopsy floor of mouth Biopsy of palate, uvula Biopsy of oropharynx D7287 Cytology s am ple collection 88104 Cytopathology, fluids, washings or brushings, except cervical or vaginal .

3 Smears with interpretation X D7288 Brush biopsy - transepithelial sample collection 88112 Cytopathology, selective cellular enhancement technique with interpretation ( Liquid based slide preparation method), except cervical or vaginal Current Den tal Termin olo gy American De nt al A sso ciatio n. A ll rig h ts re s erv ed. 01/01/2018 D7295 Harve s t of bone for use in autogenous grafting procedures 21215, 21210 - includes obtaining the graft, in which case this code would not be covered 20900 - bone graft any donor area D7296 Corticotomy - one to three teeth or tooth spaces, per quadrant 21198-52 Osteotomy, mandible, segmental.

4 X D7297 Corticotomy four or more teeth or tooth spaces, per quadrant 21206-52 Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard) X D7410 Excision of benign lesion up to cm 21015 Radical resection of tumor ( , malignant neoplasm); s oft tissue of fac e or scalp D7411 Excision of benign lesion greater than cm 21030 21040 Excision of benign tum or or cyst of maxilla or zygoma by enucleation and curettage Excision of benign tum or or cyst of mandible, by enucleation and curettage D7412 Excision of benign lesion, complicated 41827 Excision of lesion or tumor, dentoalveolar structures.

5 With complex repair D7413 Excision of malignant lesion up to cm 21034 21044 Excision of malignant tumor of maxilla or zygoma Excision of malignant tumor of mandible D7414 Excision of malignant lesion greater than 1. 25 cm 21034 21044 Excision of malignant tumor of maxilla or zygoma Excision of malignant tumor of mandible D7415 Excision of malignant lesion, complicated 21034 21044 21045 Excision of malignant tumor of maxilla or zygoma Excision of malignant tumor of mandible Excision of malignant tumor of mandible; radical resection Current Den tal Termin olo gy American De nt al A sso ciatio n.

6 A ll rig h ts re s erv ed. 01/01/2018 D7440 Excision of malignant t um or lesion diameter up to cm 21034 Excision of malignant tumor of maxilla or zygoma Excision of malignant tumor of mandible; Excision of malignant tumor of mandible; radical resection 21044 21045 D7441 Excis ion of malignant t umor lesion diameter over cm 21034 Excision of malignant tumor of maxilla or zygoma 21044 21045 Excision of malignant tumor of mandible; Excision of malignant tumor of mandible.

7 Radical resection D7450 Removal of benign odontogenic cyst or tumor; lesion diameter up to cm 21030 21040 41825 41826 41827 Excision of benign tum or or cyst of maxilla or zygoma by enucleation and curettage Excision of benign cyst or tumor of mandible, by enucleation and/or curettage Excision of lesion or tumor, dentoalveolar structures; without repair Excision of lesion or tumor, dentoalveolar structures; with simple repair Excision of lesion or tumor, dentoalveolar structures; with complex repair Review when submitted in conjunction wit h removal of impacted teeth Current Den tal Termin olo gy American De nt al A sso ciatio n.

8 A ll rig h ts re s erv ed. 01/01/2018 D7451 Removal of benign odontogenic cyst or tumor; lesion diameter greater than cm 21030 21040 41825 41826 41827 Excision of benign tum or or cyst of maxilla or zygoma by enucleation and curettage Excision of benign cyst or tumor of mandible, by enucleation and/or curettage Excision of lesion or tumor, dentoalveolar structures; without repair Excision of lesion or tumor, dentoalveolar structures; with simple repair Excision of lesion or tumor, dentoalveolar structures; with complex repair Review when submitted in conjunction wit h removal of impacted teeth D7460 Removal of benign non-odontogenic cyst or tumor.

9 Lesion diameter up to cm 21030 21040 41825 41826 41827 Excision of benign tum or or cyst of maxilla or zygoma by enucleation and curettage Excision of benign cyst or tumor of mandible, by enucleation and/or curettage Excision of lesion or tumor, dentoalveolar structures; without repair Excision of lesion or tumor, dentoalveolar structures; with simple repair Excision of lesion or tumor, dentoalveolar structures; with complex repair Current Den tal Termin olo gy American De nt al A sso ciatio n.

10 A ll rig h ts re s erv ed. 01/01/2018 D7461 Removal of benign non-odontogenic cyst or tumor; lesion diameter greater than cm 21030 21040 41825 41826 41827 Excision of benign tum or or cyst of maxilla or zygoma by enucleation and curettage Excision of benign cyst or tumor of mandible, by enucleation and/or curettage Excision of lesion or tumor, dentoalveolar structures; without repair Excision of lesion or tumor, dentoalveolar structures; with simple repair Excision of lesion or tumor, dentoalveolar structures; with complex repair D7465 Destruction of lesion(s) by physical or chemical methods by report 40820 41850 42160 Destruction of lesion or scar of vestibule of mouth by physical methods Destruction of lesion.