C6739
Excision of lesion(s) of cervix, including by cauterization/cryosurgery, in surgical day care
5 315,00
C6759
Cerclage/repair of uterine cervix, in surgical day care
C7011
Hymenotomy/hymenectomy, in surgical day care
C7024
Biopsy/excision/destruction of lesion(s) of vagina, in surgical day care
C7129
Bartholin's gland/cyst operation under general anesthesia, in surgical day care
C7744
Biopsy of bone/arthrotomy of hand/foot and finger(s)/toe(s), in surgical day care
C7751
Bunion, eg, hallux valgus / hammer toe/claw operation, in surgical day care
C7860
Removal of implanted device from bone, excluding face/hand/foot, in surgical day care
C8044
Capsulotomy of hand/foot and finger(s)/toe(s), in surgical day care
C8201
Tendon sheath incision, in surgical day care
C8313
Tenotomy, excluding of hand, in surgical day care
C8331
Excision of lesion(s) of tendon sheath, in surgical day care
C8350
Excision of bursa, in surgical day care
C8611
Biopsy of subcutaneous tissue under general anesthesia, in surgical day care
C8630
Excision/destruction of lesions of skin and subcutaneous tissue, 4 or more, in surgical day care
C8660
Free skin grafting, includes excision of skin for autogenous graft, in surgical day care
C8689
Repair and reconstruction of skin and subcutaneous tissue, in surgical day care
C8694
Implantation/replacement of sacral nerve stimulation generator, in surgical day care, excluding device cost
C9802
Esophagoscopy for removal of foreign body, in surgical day care
C999C
Surgical hospital day care, excluding procedures with specific code
D0210
Intra oral radiograph - complete series
497,00
D0220
Intraoral periapical film
54,00
D0230
Intraoral periapical, each additional film
D0240
Intraoral occlusal film
120,00
D0330
Panoramic film
441,00
D1201
Application of fluoride, complete
138,00
D1351
Sealant - per tooth
204,00
D1510
Space maintainer, fixed
1 029,00
D2140
Restoration - one surface, local anesthesia
347,00
D2150
Restoration -2/more surfaces, any material
D2330
Resin-based composite restoration - one surface, anterior
593,00
D2335
Resin-based composite restoration, anterior
732,00
D2390
Resin-based composite restoration - crown
638,00
D2752
Crown - porcelain fused to noble metal
3 749,00
D2980
Crown repair
342,00
D3220
Pulpotomy, primary/permanent tooth
321,00
D3230
Pulpal therapy, resorbable filling - primary tooth, excluding final restoration
D3310
Root canal therapy - anterior, excluding final restoration
1 308,00
D3320
Root canal therapy - bicuspid, excluding final restoration
D3330
Root canal therapy - molar, excluding final restoration
D3351
Apexification
525,00
D3410
Apicoectomy, anterior, including placement of retrograde filling material
1 311,00
D3421
Apicoectomy - bicuspid, including placement of retrograde filling material
1 635,00
D3425
Apicoectomy - molar, including placement of retrograde filling material
2 780,00
D3450
Root amputation
D3920
Hemisection
1 146,00
D4240
Gingival flap, with root planing, per quadrant
1 124,00
D4249
Clinical crown lengthening
1 047,00
D4260
Osseous surgery, including flap entry and closure, per quadrant
1 445,00
D4341
Periodontal scaling and root planing, per meeting, 30 minutes
194,00
D5110
Complete acrylic denture - pair
10 964,00
D5213
Partial denture
10 104,00
D5730
Reline denture (chairside)
1 170,00
D5750
Reline denture - laboratory
2 886,00
D5951
Feeding aid; feeding prosthesis
906,00
D5952
Speech aid prosthesis, pediatric
D7111
Extraction, coronal remnants - deciduous tooth
345,00
D7140
Extraction, erupted tooth or exposed root, single
D7141
Extraction, erupted tooth or exposed root, second in the same session
257,00
D7142
Extraction, erupted tooth or exposed root, each additional tooth in the same session
171,00
D7210
Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth
359,00
D7220
Removal of impacted tooth - soft tissue
819,00
D7230
Removal of impacted tooth - partially bony
D7240
Removal of impacted tooth - completely bony
D7270
Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth and/or alveolus
834,00
D7280
Exposure of impacted/unerupted tooth for orthodontic reasons, including orthodontic attachments
D7320
Alveoloplasty not in conjunction with extractions - per quadrant
843,00
D7340
Vestibuloplasty - ridge extension (secondary epithelialization)
1 119,00
D7450
Removal of odontogenic cyst
D7960
Frenulectomy (frenectomy or frenotomy)
D8080
Comprehensive orthodontic treatment of the adolescent dentition, for one year, up to 3 years
5 835,00
D8089
Follow up code of D8080, established adolescent patient for comprehensive orthodontic treatment
0,00
D8999
Orthodontic preparation for orthognatic face mask
2 201,00
D9110
Emergency treatment of dental pain
243,00
D9220
Deep sedation/general anesthesia, for dental procedure - first hour
1 734,00
