Standard_v0.9_map_only 494

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX5936 10701 TX5937 obturator prosthesis, interim D5936 obturator prosthesis, interim 240-74-13 Obturator prosthesis, interim Trismus appliance (not for TMD 10702 TX5951 trismus appliance (not for TMD D5937 trismus appliance (not for TMD 162-74-10 10703 TX5952 treatment) 10704 TX5953 treatment) treatment) 10705 TX5954 10706 TX5955 feeding aid D5951 feeding aid 10707 TX5958 10708 TX5959 speech aid prosthesis, pediatric D5952 speech aid prosthesis, pediatric 10709 TX5960 speech aid prosthesis, adult D5953 speech aid prosthesis, adult 10710 TX5982 palatal augmentation prosthesis D5954 palatal augmentation prosthesis 10711 TX5983 10712 TX5984 palatal lift prosthesis, definitive D5955 palatal lift prosthesis, definitive 10713 TX5985 10714 TX5986 palatal lift prosthesis, interim D5958 palatal lift prosthesis, interim 10715 TX5987 10716 TX5988 palatal lift prosthesis, modification D5959 palatal lift prosthesis, modification 10717 TX5991 speech aid prosthesis, D5960 speech aid prosthesis, 10718 TX5992 modification modification surgical stent 10719 TX5993 radiation carrier surgical stent D5982 radiation shield TX5994 radiation cone locator radiation carrier D5983 fluoride gel carrier TX5995 commissure splint radiation shield D5984 surgical splint vesiculobullous disease radiation cone locator D5985 medicament carrier adjust maxillofacial prosthetic fluoride gel carrier D5986 appliance, by report maintenance and cleaning of a commissure splint D5987 maxillofacial prosthesis (extra- or intra-oral) other than required surgical splint D5988 adjustments, by report periodontal medicament carrier vesiculobullous disease D5991 with peripheral seal – laboratory processed medicament carrier periodontal medicament carrier with peripheral seal – laboratory adjust maxillofacial prosthetic D5992 processed – maxillary appliance, by report maintenance and cleaning of a D5993 maxillofacial prosthesis (extra- or intra-oral) other than required 10720 adjustments, by report 10721 periodontal medicament carrier D5994 with peripheral seal – laboratory processed periodontal medicament carrier D5995 with peripheral seal – laboratory processed – maxillary 10722 Page 451

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX5996 periodontal medicament carrier D5996 periodontal medicament carrier Unspecified maxillofacial TX5999 prosthesis, by report TX6010 with peripheral seal – laboratory with peripheral seal – laboratory Surgical placement of implant TX6011 body(fixture): endosteal implant 10723 processed – mandibular processed – mandibular 10724 TX6012 10725 unspecified maxillofacial D5999 unspecified maxillofacial 154-74-99 TX6013 TX6040 prosthesis, by report prosthesis, by report TX6050 TX6051 surgical placement of implant D6010 surgical placement of implant 233-75-10 TX6052 TX6055 body: endosteal implant body: endosteal implant TX6056 surgical access to an implant D6011 surgical access to an implant TX6057 body (second stage implant body (second stage implant TX6058 10726 TX6059 surgery) surgery) surgical placement of interim D6012 surgical placement of interim implant body for transitional implant body for transitional 10727 prosthesis: endosteal implant prosthesis: endosteal implant 10728 10729 surgical placement of mini implant D6013 surgical placement of mini implant 10730 10731 surgical placement: eposteal D6040 surgical placement: eposteal 233-75-14 Surgical placement: eposteal 10732 implant implant implant Surgical placement: transosteal implant surgical placement: transosteal D6050 surgical placement: transosteal 233-75-14 Dental implant supported implant implant connecting bar interim abutment D6051 interim abutment semi-precision attachment D6052 semi-precision attachment abutment abutment connecting bar – implant D6055 connecting bar – implant 233-75-22 supported or abutment supported supported or abutment supported 10733 prefabricated abutment – D6056 prefabricated abutment – 233-75-20 Prefabricated abutment includes modification and includes modification and Custom abutment 10734 placement placement Abutment supported 10735 porcelain/ceramic crown 10736 custom fabricated abutment – D6057 custom fabricated abutment – 233-75-21 Abutment supported porcelain fused to metal crown (high noble includes placement includes placement metal) abutment supported D6058 abutment supported 233-75-23 porcelain/ceramic crown porcelain/ceramic crown abutment supported porcelain D6059 abutment supported porcelain 233-75-24 fused to metal crown (high noble fused to metal crown (high noble 10737 metal) metal) Page 452

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX6060 abutment supported porcelain D6060 abutment supported porcelain 233-75-25 Abutment supported porcelain TX6061 fused to metal crown fused to metal crown fused to metal crown (predominantly base metal) TX6062 Abutment supported porcelain 10738 TX6063 (predominantly base metal) (predominantly base metal) fused to metal crown (noble metal) TX6064 abutment supported porcelain D6061 abutment supported porcelain 233-75-26 TX6065 TX6066 fused to metal crown (noble metal) fused to metal crown (noble metal) 10739 TX6067 abutment supported cast metal D6062 abutment supported cast metal 233-75-27 Abutment supported cast metal 10740 crown (high noble metal) crown (high noble metal) crown (high noble metal) TX6068 abutment supported cast metal D6063 abutment supported cast metal 233-75-28 Abutment supported cast metal TX6069 crown (predominantly base metal) crown (predominantly base metal) crown (predominantly base metal) 10741 TX6070 abutment supported cast metal D6064 abutment supported cast metal 233-75-29 Abutment supported cast metal 10742 crown (noble metal) D6065 crown (noble metal) 233-75-40 crown (noble metal) 10743 TX6071 implant supported D6066 implant supported 233-75-41 Implant supported porcelain/ceramic crown porcelain/ceramic crown porcelain/ceramic crown TX6072 implant supported crown - implant supported crown - Implant supported crown - porcelain fused to high noble porcelain fused to high noble porcelain fused to metal crown, alloys alloys titanium, titanium alloy, high noble metal 10744 implant supported crown - high D6067 implant supported crown - high 233-75-42 Implant supported Metal crown, 10745 noble alloys noble alloys titanium, titanium alloy, high noble 10746 metal 10747 abutment supported retainer for D6068 abutment supported retainer for 233-75-30 Abutment supported retainer for 10748 porcelain/ceramic FPD porcelain/ceramic FPD porcelain/ceramic FPD 10749 abutment supported retainer for D6069 abutment supported retainer for 233-75-31 Abutment supported retainer for 10750 porcelain fused to metal FPD porcelain fused to metal FPD porcelain fused to metal FPD (high noble metal) (high noble metal) (high noble metal) abutment supported retainer for D6070 abutment supported retainer for 233-75-32 Abutment supported retainer for porcelain fused to metal FPD porcelain fused to metal FPD porcelain fused to metal FPD (predominantly base metal) (predominantly base metal) (predominantly base metal) abutment supported retainer for D6071 abutment supported retainer for 233-75-33 Abutment supported retainer for porcelain fused to metal FPD porcelain fused to metal FPD porcelain fused to metal FPD (noble metal) (noble metal) (noble metal) abutment supported retainer for D6072 abutment supported retainer for 233-75-34 Abutment supported retainer for cast metal FPD (high noble metal) cast metal FPD (high noble metal) cast metal FPD (high noble metal) Page 453

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX6073 D6073 abutment supported retainer for 233-75-35 10751 abutment supported retainer for cast metal FPD (predominantly Abutment supported retainer for 10752 TX6074 cast metal FPD (predominantly D6074 base metal) 233-75-36 cast metal FPD (predominantly 10753 TX6075 base metal) abutment supported retainer for 233-75-43 base metal) TX6076 abutment supported retainer for D6075 cast metal FPD (noble metal) 233-75-44 Abutment supported retainer for cast metal FPD (noble metal) implant supported retainer for cast metal FPD (noble metal) TX6077 implant supported retainer for D6076 ceramic FPD 233-75-45 Implant supported retainer for ceramic FPD implant supported retainer for ceramic FPD implant supported retainer for FPD - porcelain fused to high Implant supported retainer for FPD - porcelain fused to high noble alloys porcelain fused to metal FPD noble alloys (titanium, titanium alloy, or high implant supported retainer for noble metal) 10754 metal FPD - high noble alloys Implant supported retainer for cast metal FPD, titanium, titanium implant supported retainer for D6077 alloy, or high noble metal metal FPD - high noble alloys 10755 TX6080 implant maintenance procedures D6080 implant maintenance procedures 233-75-60 Implant maintenance procedures, when prostheses are removed including removal of prosthesis, TX6081 when prostheses are removed and reinserted, including cleansing of prosthesis and cleansing of prostheses and abutment and reinsertion of TX6082 and reinserted, including abutments prosthesis TX6083 scaling and debridement in the TX6084 cleansing of prostheses and presence of inflammation or TX6085 mucositis of a single implant, 10756 TX6086 abutments including cleaning of the implant surfaces, without flap entry and scaling and debridement in the D6081 closure implant supported crown - presence of inflammation or porcelain fused to predominantly base alloys mucositis of a single implant, implant supported crown - porcelain fused to noble alloys including cleaning of the implant implant supported crown - porcelain fused to titanium and surfaces, without flap entry and titanium alloys provisional implant crown 10757 closure implant supported crown - predominantly base alloys 10758 implant supported crown - D6082 10759 porcelain fused to predominantly 10760 10761 base alloys 10762 implant supported crown - D6083 porcelain fused to noble alloys implant supported crown - D6084 porcelain fused to titanium and titanium alloys provisional implant crown D6085 implant supported crown - D6086 predominantly base alloys Page 454

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX6087 Repair implant supported 10763 TX6088 implant supported crown - noble D6087 implant supported crown - noble prosthesis, by report TX6090 10764 TX6091 alloys alloys Repair implant abutment, by report 10765 TX6092 implant supported crown - D6088 implant supported crown - TX6093 titanium and titanium alloys titanium and titanium alloys TX6094 repair implant supported D6090 repair implant supported 233-75-80 TX6095 TX6096 prosthesis, by report prosthesis, by report TX6097 replacement of replaceable part D6091 replacement of replaceable part TX6098 of semi-precision or precision of semi-precision or precision TX6099 attachment (male or female attachment (male or female TX6100 component) of implant/abutment component) of implant/abutment supported prosthesis, per supported prosthesis, per 10766 attachment attachment 10767 re-cement or re-bond D6092 re-cement or re-bond 10768 implant/abutment supported implant/abutment supported 10769 10770 crown crown 10771 re-cement or re-bond D6093 re-cement or re-bond 10772 implant/abutment supported fixed implant/abutment supported fixed 10773 partial denture partial denture 10774 10775 abutment supported crown - D6094 abutment supported crown - titanium and titanium alloys titanium and titanium alloys repair implant abutment, by report D6095 repair implant abutment, by report 233-75-70 remove broken implant retaining D6096 remove broken implant retaining screw screw abutment supported crown - porcelain fused to titanium and abutment supported crown - D6097 titanium alloys implant supported retainer - porcelain fused to titanium and porcelain fused to predominantly base alloys titanium alloys implant supported retainer for FPD - porcelain fused to noble implant supported retainer - D6098 alloys implant removal, by report porcelain fused to predominantly base alloys implant supported retainer for D6099 FPD - porcelain fused to noble alloys implant removal, by report D6100 Page 455

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX6101 debridement of a peri-implant D6101 debridement of a peri-implant TX6102 defect or defects surrounding a defect or defects surrounding a single implant, and surface TX6103 cleaning of the exposed implant TX6104 single implant, and surface surfaces, including flap entry and TX6110 closure TX6111 cleaning of the exposed implant debridement and osseous TX6112 contouring of a peri-implant TX6113 surfaces, including flap entry and defect or defects surrounding a TX6114 single implant and includes 10776 TX6115 closure surface cleaning of the exposed implant surfaces, including flap debridement and osseous D6102 entry and closure bone graft for repair of peri- contouring of a peri-implant implant defect – does not include flap entry and closure defect or defects surrounding a bone graft at time of implant placement single implant and includes implant /abutment supported removable denture for edentulous surface cleaning of the exposed arch – maxillary implant /abutment supported implant surfaces, including flap removable denture for edentulous arch – mandibular 10777 entry and closure D6103 implant /abutment supported 10778 bone graft for repair of peri- removable denture for partially 10779 edentulous arch – maxillary 10780 implant defect – does not include implant /abutment supported 10781 removable denture for partially 10782 flap entry and closure edentulous arch – mandibular 10783 implant /abutment supported 10784 bone graft at time of implant D6104 fixed denture for edentulous arch 10785 – maxillary placement implant /abutment supported fixed denture for edentulous arch implant /abutment supported D6110 – mandibular removable denture for edentulous arch – maxillary implant /abutment supported D6111 removable denture for edentulous arch – mandibular implant /abutment supported D6112 removable denture for partially edentulous arch – maxillary implant /abutment supported D6113 removable denture for partially edentulous arch – mandibular implant /abutment supported D6114 fixed denture for edentulous arch – maxillary implant /abutment supported D6115 fixed denture for edentulous arch – mandibular Page 456

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX6116 implant /abutment supported D6116 implant /abutment supported Unspecified implant procedure, TX6117 by report fixed denture for partially fixed denture for partially TX6118 10786 edentulous arch – maxillary edentulous arch – maxillary TX6119 implant /abutment supported D6117 implant /abutment supported TX6120 fixed denture for partially fixed denture for partially TX6121 10787 edentulous arch – mandibular edentulous arch – mandibular TX6122 TX6123 implant/abutment supported D6118 implant/abutment supported TX6190 interim fixed denture for interim fixed denture for TX6191 10788 TX6192 edentulous arch – mandibular edentulous arch – mandibular TX6194 implant/abutment supported D6119 implant/abutment supported TX6195 interim fixed denture for interim fixed denture for TX6199 10789 edentulous arch – maxillary edentulous arch – maxillary implant supported retainer – D6120 implant supported retainer – porcelain fused to titanium and porcelain fused to titanium and 10790 titanium alloys titanium alloys implant supported retainer for D6121 implant supported retainer for metal FPD – predominantly base metal FPD – predominantly base 10791 alloys alloys 10792 implant supported retainer for D6122 implant supported retainer for metal FPD – noble alloys metal FPD – noble alloys implant supported retainer for D6123 implant supported retainer for metal FPD – titanium and titanium metal FPD – titanium and titanium 10793 alloys alloys 10794 10795 radiographic/surgical implant D6190 radiographic/surgical implant 10796 index, by report index, by report semi-precision abutment – D6191 semi-precision abutment – placement placement semi-precision attachment – D6192 semi-precision attachment – placement placement abutment supported retainer D6194 abutment supported retainer crown for FPD – titanium and crown for FPD – titanium and 10797 titanium alloys titanium alloys abutment supported retainer - D6195 abutment supported retainer - porcelain fused to titanium and porcelain fused to titanium and 10798 titanium alloys titanium alloys 10799 unspecified implant procedure, D6199 unspecified implant procedure, 233-75-99 by report by report Page 457

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX6205 D6205 10800 TX6210 pontic - indirect resin based pontic - indirect resin based 238-74-K1 Pontic - Full cast high noble metal TX6211 D6210 10801 TX6212 composite composite TX6214 pontic - cast high noble metal pontic - cast high noble metal 10802 TX6240 10803 TX6241 pontic - cast predominantly base D6211 pontic - cast predominantly base 238-74-K2 Pontic - Full cast predominantly TX6242 base metal 10804 TX6243 metal metal Pontic - Full cast noble metal TX6245 10805 TX6250 pontic - cast noble metal D6212 pontic - cast noble metal 238-74-K3 Pontic - porcelain fused to high TX6251 noble metal 10806 TX6252 pontic - titanium and titanium D6214 pontic - titanium and titanium Pontic - porcelain fused to TX6253 predominantly base metal 10807 alloys alloys Pontic - porcelain fused to noble TX6545 metal 10808 TX6548 pontic - porcelain fused to high D6240 pontic - porcelain fused to high 238-74-J1 10809 TX6549 Pontic - porcelain/ceramic TX6600 noble metal noble metal Pontic - resin with high noble 10810 metal pontic - porcelain fused to D6241 pontic - porcelain fused to 238-74-J2 Pontic - resin with predominantly 10811 base metal 10812 predominantly base metal predominantly base metal Pontic - resin with noble metal pontic - porcelain fused to noble D6242 pontic - porcelain fused to noble 238-74-J3 Retainer - cast metal for resin bonded fixed prosthesis metal metal Retainer - porcelain/ceramic for resin bonded fixed prosthesis pontic - porcelain fused to D6243 pontic - porcelain fused to titanium and titanium alloys titanium and titanium alloys pontic - porcelain/ceramic D6245 pontic - porcelain/ceramic 238-74-M1 pontic - resin with high noble D6250 pontic - resin with high noble 238-74-L1 metal metal pontic - resin with predominantly D6251 pontic - resin with predominantly 238-74-L2 base metal base metal pontic - resin with noble metal D6252 pontic - resin with noble metal 238-74-L3 provisional pontic - further D6253 provisional pontic - further treatment or completion of treatment or completion of diagnosis necessary prior to final diagnosis necessary prior to final 10813 impression impression 10814 10815 retainer - cast metal for resin D6545 retainer - cast metal for resin 238-74-F1 10816 10817 bonded fixed prosthesis bonded fixed prosthesis retainer - porcelain/ceramic for D6548 retainer - porcelain/ceramic for 238-74-F2 resin bonded fixed prosthesis resin bonded fixed prosthesis retainer – for resin bonded fixed D6549 retainer – for resin bonded fixed prosthesis prosthesis retainer inlay - porcelain/ceramic, D6600 retainer inlay - porcelain/ceramic, two surfaces two surfaces Page 458

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX6601 retainer inlay - porcelain/ceramic, D6601 retainer inlay - porcelain/ceramic, TX6602 TX6603 three or more surfaces three or more surfaces TX6604 10818 retainer inlay - cast high noble D6602 retainer inlay - cast high noble 10819 TX6605 metal, two surfaces metal, two surfaces 10820 retainer inlay - cast high noble D6603 retainer inlay - cast high noble TX6606 metal, three or more surfaces metal, three or more surfaces TX6607 retainer inlay - cast predominantly D6604 retainer inlay - cast predominantly TX6608 base metal, two surfaces base metal, two surfaces TX6609 10821 TX6610 TX6611 retainer inlay - cast predominantly D6605 retainer inlay - cast predominantly TX6612 base metal, three or more base metal, three or more surfaces TX6613 retainer inlay - cast noble metal, 10822 surfaces two surfaces 10823 TX6614 retainer inlay - cast noble metal, 10824 TX6615 retainer inlay - cast noble metal, D6606 three or more surfaces 10825 TX6624 retainer onlay - two surfaces porcelain/ceramic, two surfaces retainer onlay - retainer inlay - cast noble metal, D6607 porcelain/ceramic, three or more surfaces three or more surfaces retainer onlay - cast high noble metal, two surfaces retainer onlay - D6608 retainer onlay - cast high noble metal, three or more surfaces porcelain/ceramic, two surfaces retainer onlay - cast predominantly base metal, two retainer onlay - D6609 surfaces retainer onlay - cast porcelain/ceramic, three or more predominantly base metal, three or more surfaces 10826 surfaces retainer onlay - cast noble metal, 10827 two surfaces 10828 retainer onlay - cast high noble D6610 retainer onlay - cast noble metal, three or more surfaces metal, two surfaces retainer inlay - titanium retainer onlay - cast high noble D6611 metal, three or more surfaces retainer onlay - cast D6612 predominantly base metal, two 10829 surfaces retainer onlay - cast D6613 predominantly base metal, three 10830 or more surfaces 10831 retainer onlay - cast noble metal, D6614 10832 two surfaces 10833 retainer onlay - cast noble metal, D6615 three or more surfaces retainer inlay - titanium D6624 Page 459

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX6634 10834 TX6710 retainer onlay - titanium D6634 retainer onlay - titanium Crown - resin with - high noble 10835 TX6720 metal 10836 TX6721 retainer crown - indirect resin D6710 retainer crown - indirect resin Crown - resin with - 10837 TX6722 predominantly base metal 10838 TX6740 based composite based composite Crown - resin with - noble metal 10839 TX6750 10840 TX6751 retainer crown - resin with high D6720 retainer crown - resin with high 238-74-D1 Crown - porcelain/ceramic 10841 TX6752 10842 TX6753 noble metal noble metal 10843 TX6780 10844 TX6781 retainer crown - resin with D6721 retainer crown - resin with 238-74-D2 10845 TX6782 10846 TX6783 predominantly base metal predominantly base metal 10847 TX6784 10848 TX6790 retainer crown - resin with noble D6722 retainer crown - resin with noble 238-74-D3 10849 TX6791 10850 TX6792 metal metal 10851 retainer crown - porcelain/ceramic D6740 retainer crown - porcelain/ceramic 238-74-E1 retainer crown - porcelain fused D6750 retainer crown - porcelain fused 238-74-A1 Crown - porcelain fused to - high to high noble metal D6751 to high noble metal 238-74-A2 noble metal retainer crown - porcelain fused D6752 retainer crown - porcelain fused 238-74-A3 Crown - porcelain fused to - to predominantly base metal D6753 to predominantly base metal predominantly base metal retainer crown - porcelain fused D6780 retainer crown - porcelain fused 238-74-C1 Crown - porcelain fused to - noble to noble metal D6781 to noble metal 238-74-C2 metal retainer crown - porcelain fused D6782 retainer crown - porcelain fused 238-74-C3 to titanium and titanium alloys D6783 to titanium and titanium alloys 238-74-C4 Retainer crown - 3/4 cast - high retainer crown - 3/4 cast high D6784 retainer crown - 3/4 cast high noble metal noble metal D6790 noble metal 238-74-B1 Retainer crown - 3/4 cast - retainer crown - 3/4 cast D6791 retainer crown - 3/4 cast 238-74-B2 predominantly base metal predominantly base metal D6792 predominantly base metal 238-74-B3 Retainer crown - 3/4 cast - noble retainer crown - 3/4 cast noble retainer crown - 3/4 cast noble metal metal metal Retainer crown - 3/4 - retainer crown - 3/4 retainer crown - 3/4 porcelain/ceramic porcelain/ceramic porcelain/ceramic retainer crown ¾ - titanium and retainer crown ¾ - titanium and Crown - full cast - high noble titanium alloys titanium alloys metal retainer crown - full cast high retainer crown - full cast high crown - full cast - predominantly noble metal noble metal base metal retainer crown - full cast retainer crown - full cast crown - full cast - noble metal predominantly base metal predominantly base metal retainer crown - full cast noble retainer crown - full cast noble metal metal Page 460

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX6793 provisional retainer crown - D6793 provisional retainer crown - Connector bar TX6794 Re-cement fixed partial denture TX6920 further treatment or completion of further treatment or completion of Stress breaker TX6930 Precision attachment TX6940 diagnosis necessary prior to final diagnosis necessary prior to final TX6950 Unspecified fixed prosthodontic 10852 TX6980 impression impression procedure, by report 10853 10854 TX6985 retainer crown - titanium and D6794 retainer crown - titanium and 10855 TX6999 10856 titanium alloys titanium alloys 10857 TX7111 TX7140 connector bar D6920 connector bar 238-74-U1 10858 10859 TX7210 re-cement or re-bond fixed partial D6930 re-cement or re-bond fixed partial 238-74-V1 10860 TX7220 denture denture 10861 TX7230 TX7240 stress breaker D6940 stress breaker 238-74-S1 10862 TX7241 precision attachment D6950 precision attachment 238-74-T1 fixed partial denture repair D6980 fixed partial denture repair necessitated by restorative necessitated by restorative material failure material failure pediatric partial denture, fixed D6985 pediatric partial denture, fixed unspecified fixed prosthodontic D6999 unspecified fixed prosthodontic 233-74-99 procedure, by report procedure, by report extraction, coronal remnants – D7111 extraction, coronal remnants – 237-27-00 Extraction (Child/Primary) primary tooth primary tooth Extraction (Adult/Permanent) extraction, erupted tooth or D7140 extraction, erupted tooth or 238-14-02 Surgical removal - Non - impacted tooth exposed root (elevation and/or exposed root (elevation and/or Surgical removal - Soft tissue forceps removal) forceps removal) impaction Surgical removal - Partial bony extraction, erupted tooth requiring D7210 extraction, erupted tooth requiring 238-26-00 impaction Surgical removal - Complete bony removal of bone and/or removal of bone and/or impaction Surgical removal - Variation of sectioning of tooth, and including sectioning of tooth, and including impaction, embedded tooth elevation of mucoperiosteal flap if elevation of mucoperiosteal flap if 10863 indicated indicated 10864 10865 removal of impacted tooth - soft D7220 removal of impacted tooth - soft 238-26-01 10866 tissue tissue 10867 removal of impacted tooth - D7230 removal of impacted tooth - 238-26-02 partially bony partially bony removal of impacted tooth - D7240 removal of impacted tooth - 238-26-03 completely bony completely bony removal of impacted tooth - D7241 removal of impacted tooth - 238-26-04 completely bony, with unusual completely bony, with unusual surgical complications surgical complications Page 461

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX7250 10868 TX7251 removal of residual tooth roots D7250 removal of residual tooth roots TX7260 (cutting procedure) 10869 TX7261 (cutting procedure) coronectomy – intentional partial 10870 TX7270 tooth removal coronectomy – intentional partial D7251 oroantral fistula closure 10871 TX7272 primary closure of a sinus tooth removal perforation TX7280 tooth re-implantation and/or TX7282 oroantral fistula closure D7260 stabilization of accidentally evulsed or displaced tooth TX7283 primary closure of a sinus D7261 tooth transplantation (includes re- TX7285 implantation from one site to TX7286 perforation another and splinting and/or TX7287 stabilization) TX7288 tooth re-implantation and/or D7270 exposure of an unerupted tooth TX7290 mobilization of erupted or TX7291 stabilization of accidentally malpositioned tooth to aid eruption TX7292 10872 evulsed or displaced tooth tooth transplantation (includes re- D7272 implantation from one site to another and splinting and/or 10873 stabilization) 10874 exposure of an unerupted tooth D7280 10875 10876 mobilization of erupted or D7282 10877 10878 malpositioned tooth to aid eruption 10879 10880 placement of device to facilitate D7283 placement of device to facilitate 10881 eruption of impacted tooth eruption of impacted tooth 10882 incisional biopsy of oral tissue- D7285 incisional biopsy of oral tissue- hard (bone, tooth) hard (bone, tooth) incisional biopsy of oral tissue-soft D7286 incisional biopsy of oral tissue-soft exfoliative cytological sample D7287 exfoliative cytological sample collection collection brush biopsy - transepithelial D7288 brush biopsy - transepithelial sample collection sample collection surgical repositioning of teeth D7290 surgical repositioning of teeth transseptal fiberotomy/supra D7291 transseptal fiberotomy/supra crestal fiberotomy, by report crestal fiberotomy, by report placement of temporary D7292 placement of temporary anchorage device [screw anchorage device [screw 10883 retained plate] requiring flap; retained plate] requiring flap; includes device removal includes device removal Page 462

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX7293 TX7294 placement of temporary D7293 placement of temporary TX7295 anchorage device requiring flap; TX7296 anchorage device requiring flap; includes device removal TX7297 placement of temporary 10884 TX7310 includes device removal anchorage device without flap; TX7311 includes device removal TX7320 placement of temporary D7294 harvest of bone for use in autogenous grafting procedure TX7321 anchorage device without flap; corticotomy – one to three teeth or tooth spaces, per quadrant 10885 TX7340 includes device removal corticotomy – four or more teeth 10886 TX7350 or tooth spaces, per quadrant 10887 harvest of bone for use in D7295 alveoloplasty in conjunction with 10888 TX7410 extractions - four or more teeth or autogenous grafting procedure tooth spaces, per quadrant alveoloplasty in conjunction with corticotomy – one to three teeth D7296 extractions - one to three teeth or tooth spaces, per quadrant or tooth spaces, per quadrant alveoloplasty not in conjunction with extractions - four or more corticotomy – four or more teeth D7297 teeth or tooth spaces, per quadrant or tooth spaces, per quadrant alveoloplasty not in conjunction with extractions - one to three alveoloplasty in conjunction with D7310 teeth or tooth spaces, per quadrant extractions - four or more teeth or vestibuloplasty - ridge extension (secondary epithelialization) 10889 tooth spaces, per quadrant vestibuloplasty - ridge extension (including soft tissue grafts, alveoloplasty in conjunction with D7311 muscle reattachment, revision of soft tissue attachment and extractions - one to three teeth or management of hypertrophied and hyperplastic tissue) 10890 tooth spaces, per quadrant excision of benign lesion up to 1.25 cm alveoloplasty not in conjunction D7320 with extractions - four or more teeth or tooth spaces, per 10891 quadrant alveoloplasty not in conjunction D7321 with extractions - one to three teeth or tooth spaces, per 10892 quadrant 10893 vestibuloplasty - ridge extension D7340 (secondary epithelialization) vestibuloplasty - ridge extension D7350 (including soft tissue grafts, muscle reattachment, revision of soft tissue attachment and management of hypertrophied 10894 and hyperplastic tissue) 10895 excision of benign lesion up to D7410 1.25 cm Page 463

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX7411 10896 TX7412 excision of benign lesion greater D7411 excision of benign lesion greater 10897 TX7413 than 1.25 cm 10898 TX7414 than 1.25 cm excision of benign lesion, 10899 TX7415 complicated 10900 TX7440 excision of benign lesion, D7412 excision of malignant lesion up to 10901 TX7441 1.25 cm complicated excision of malignant lesion TX7450 greater than 1.25 cm excision of malignant lesion up to D7413 excision of malignant lesion, TX7451 complicated 1.25 cm excision of malignant tumor - TX7460 lesion diameter up to 1.25 cm excision of malignant lesion D7414 excision of malignant tumor - TX7461 lesion diameter greater than 1.25 greater than 1.25 cm cm TX7465 removal of benign odontogenic excision of malignant lesion, D7415 cyst or tumor - lesion diameter up TX7471 to 1.25 cm TX7472 complicated removal of benign odontogenic TX7473 cyst or tumor - lesion diameter TX7485 excision of malignant tumor - D7440 greater than 1.25 cm removal of benign lesion diameter up to 1.25 cm nonodontogenic cyst or tumor - lesion diameter up to 1.25 cm excision of malignant tumor - D7441 removal of benign nonodontogenic cyst or tumor - lesion diameter greater than 1.25 lesion diameter greater than 1.25 cm 10902 cm destruction of lesion(s) by physical or chemical method, by removal of benign odontogenic D7450 report removal of lateral exostosis cyst or tumor - lesion diameter up (maxilla or mandible) removal of torus palatinus 10903 to 1.25 cm removal of torus mandibularis reduction of osseous tuberosity removal of benign odontogenic D7451 cyst or tumor - lesion diameter 10904 greater than 1.25 cm removal of benign D7460 nonodontogenic cyst or tumor - 10905 lesion diameter up to 1.25 cm removal of benign D7461 nonodontogenic cyst or tumor - lesion diameter greater than 1.25 10906 cm 10907 destruction of lesion(s) by D7465 10908 physical or chemical method, by 10909 10910 report 10911 removal of lateral exostosis D7471 (maxilla or mandible) removal of torus palatinus D7472 removal of torus mandibularis D7473 reduction of osseous tuberosity D7485 Page 464

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX7490 10912 TX7510 radical resection of maxilla or D7490 radical resection of maxilla or TX7511 mandible 10913 mandible incision and drainage of abscess - TX7520 intraoral soft tissue TX7521 incision and drainage of abscess - D7510 incision and drainage of abscess - intraoral soft tissue - complicated TX7530 intraoral soft tissue (includes drainage of multiple fascial spaces) TX7540 incision and drainage of abscess - D7511 incision and drainage of abscess - extraoral soft tissue TX7550 intraoral soft tissue - complicated incision and drainage of abscess - extraoral soft tissue - TX7560 (includes drainage of multiple complicated (includes drainage TX7610 of multiple fascial spaces) 10914 TX7620 fascial spaces) removal of foreign body from 10915 TX7630 mucosa, skin, or subcutaneous TX7640 incision and drainage of abscess - D7520 alveolar tissue TX7650 removal of reaction producing TX7660 extraoral soft tissue foreign bodies, musculoskeletal system incision and drainage of abscess - D7521 partial ostectomy/sequestrectomy for removal of non-vital bone extraoral soft tissue - complicated (includes drainage 10916 of multiple fascial spaces) 10917 removal of foreign body from D7530 10918 mucosa, skin, or subcutaneous 10919 alveolar tissue 10920 10921 removal of reaction producing D7540 10922 10923 foreign bodies, musculoskeletal 10924 10925 system 10926 partial ostectomy/sequestrectomy D7550 for removal of non-vital bone maxillary sinusotomy for removal D7560 maxillary sinusotomy for removal of tooth fragment or foreign body D7610 of tooth fragment or foreign body maxilla - open reduction (teeth D7620 maxilla - open reduction (teeth immobilized, if present) D7630 immobilized, if present) maxilla - closed reduction (teeth D7640 maxilla - closed reduction (teeth immobilized, if present) D7650 immobilized, if present) mandible - open reduction (teeth D7660 mandible - open reduction (teeth immobilized, if present) immobilized, if present) mandible - closed reduction mandible - closed reduction (teeth immobilized, if present) (teeth immobilized, if present) malar and/or zygomatic arch - malar and/or zygomatic arch - open reduction open reduction malar and/or zygomatic arch - malar and/or zygomatic arch - closed reduction closed reduction Page 465

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX7670 10927 alveolus - closed reduction, may D7670 alveolus - closed reduction, may TX7671 include stabilization of teeth 10928 include stabilization of teeth alveolus - open reduction, may TX7680 include stabilization of teeth alveolus - open reduction, may D7671 facial bones - complicated TX7710 reduction with fixation and TX7720 include stabilization of teeth multiple surgical approaches TX7730 maxilla - open reduction TX7740 facial bones - complicated D7680 maxilla - closed reduction TX7750 mandible - open reduction reduction with fixation and mandible - closed reduction TX7760 malar and/or zygomatic arch - 10929 multiple surgical approaches open reduction 10930 TX7770 malar and/or zygomatic arch - 10931 maxilla - open reduction D7710 closed reduction 10932 TX7771 alveolus - open reduction 10933 maxilla - closed reduction D7720 stabilization of teeth TX7780 alveolus, closed reduction 10934 mandible - open reduction D7730 stabilization of teeth TX7810 facial bones - complicated 10935 TX7820 mandible - closed reduction D7740 reduction with fixation and TX7830 multiple approaches 10936 TX7840 malar and/or zygomatic arch - D7750 open reduction of dislocation TX7850 closed reduction of dislocation 10937 open reduction manipulation under anesthesia TX7852 condylectomy TX7854 malar and/or zygomatic arch - D7760 surgical discectomy, with/without TX7856 implant TX7858 closed reduction disc repair TX7860 synovectomy TX7865 alveolus - open reduction D7770 myotomy TX7870 joint reconstruction TX7871 stabilization of teeth arthrotomy arthroplasty alveolus, closed reduction D7771 arthrocentesis non-arthroscopic lysis and lavage stabilization of teeth facial bones - complicated D7780 reduction with fixation and 10938 multiple approaches 10939 10940 open reduction of dislocation D7810 10941 10942 closed reduction of dislocation D7820 10943 manipulation under anesthesia D7830 10944 10945 condylectomy D7840 10946 10947 surgical discectomy, with/without D7850 10948 10949 implant 10950 disc repair D7852 10951 synovectomy D7854 myotomy D7856 joint reconstruction D7858 arthrotomy D7860 arthroplasty D7865 arthrocentesis D7870 non-arthroscopic lysis and lavage D7871 Page 466

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX7872 10952 TX7873 arthroscopy - diagnosis, with or D7872 arthroscopy - diagnosis, with or TX7874 without biopsy 10953 TX7875 without biopsy arthroscopy: lavage and lysis of TX7876 adhesions 10954 TX7877 arthroscopy: lavage and lysis of D7873 arthroscopy: disc repositioning 10955 TX7880 and stabilization 10956 TX7881 adhesions arthroscopy: synovectomy 10957 TX7899 arthroscopy: discectomy TX7910 arthroscopy: disc repositioning D7874 arthroscopy: debridement 10958 TX7911 occlusal orthotic device, by report TX7912 and stabilization 10959 TX7920 arthroscopy: synovectomy D7875 10960 TX7921 arthroscopy: discectomy D7876 10961 TX7922 10962 arthroscopy: debridement D7877 TX7940 10963 TX7941 occlusal orthotic device, by report D7880 TX7943 occlusal orthotic device D7881 occlusal orthotic device adjustment adjustment unspecified TMD therapy, by report unspecified TMD therapy, by D7899 suture of recent small wounds up to 5 cm report complicated suture - up to 5 cm complicated suture - greater than suture of recent small wounds up D7910 5 cm skin graft (identify defect covered, to 5 cm location and type of graft) complicated suture - up to 5 cm D7911 complicated suture - greater than D7912 5 cm skin graft (identify defect covered, D7920 location and type of graft) 10964 collection and application of D7921 collection and application of autologous blood concentrate autologous blood concentrate product placement of intra-socket 10965 product biological dressing to aid in hemostasis or clot stabilization, placement of intra-socket D7922 per site osteoplasty - for orthognathic biological dressing to aid in deformities osteotomy - mandibular rami hemostasis or clot stabilization, osteotomy - mandibular rami with bone graft; includes obtaining the 10966 per site graft 10967 10968 osteoplasty - for orthognathic D7940 10969 deformities osteotomy - mandibular rami D7941 osteotomy - mandibular rami with D7943 bone graft; includes obtaining the graft Page 467

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX7944 10970 TX7945 osteotomy - segmented or D7944 osteotomy - segmented or 10971 TX7946 subapical 10972 TX7947 subapical osteotomy - body of mandible 10973 TX7948 LeFort I (maxilla - total) osteotomy - body of mandible D7945 LeFort I (maxilla - segmented) TX7949 LeFort II or LeFort III (osteoplasty TX7950 LeFort I (maxilla - total) D7946 of facial bones for midface hypoplasia or retrusion) - without TX7951 LeFort I (maxilla - segmented) D7947 bone graft LeFort II or LeFort III - with bone TX7952 LeFort II or LeFort III (osteoplasty D7948 graft TX7953 osseous, osteoperiosteal, or TX7955 of facial bones for midface cartilage graft of the mandible or TX7960 maxilla - autogenous or hypoplasia or retrusion) - without nonautogenous, by report TX7961 sinus augmentation with bone or 10974 TX7962 bone graft bone substitutes via a lateral 10975 TX7963 open approach TX7970 LeFort II or LeFort III - with bone D7949 sinus augmentation via a vertical TX7971 approach graft bone replacement graft for ridge preservation - per site osseous, osteoperiosteal, or D7950 repair of maxillofacial soft and/or hard tissue defect cartilage graft of the mandible or frenulectomy - also known as frenectomy or frenotomy - maxilla - autogenous or separate procedure not incidental to another procedure 10976 nonautogenous, by report buccal / labial frenectomy (frenulectomy) 10977 sinus augmentation with bone or D7951 lingual frenectomy (frenulectomy) 10978 10979 bone substitutes via a lateral 10980 open approach sinus augmentation via a vertical D7952 approach bone replacement graft for ridge D7953 preservation - per site repair of maxillofacial soft and/or D7955 hard tissue defect frenulectomy - also known as D7960 frenectomy or frenotomy - separate procedure not incidental 10981 to another procedure 10982 buccal / labial frenectomy D7961 10983 (frenulectomy) 10984 lingual frenectomy (frenulectomy) D7962 10985 10986 frenuloplasty D7963 frenuloplasty excision of hyperplastic tissue - D7970 excision of hyperplastic tissue - per arch per arch excision of pericoronal gingiva D7971 excision of pericoronal gingiva Page 468

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX7972 10987 surgical reduction of fibrous D7972 surgical reduction of fibrous Unspecified restorative 10988 TX7979 procedure, by report 10989 TX7980 tuberosity tuberosity TX7981 10990 non – surgical sialolithotomy D7979 non – surgical sialolithotomy 10991 TX7982 10992 TX7983 surgical sialolithotomy D7980 surgical sialolithotomy 10993 TX7990 10994 TX7991 excision of salivary gland, by D7981 excision of salivary gland, by TX7993 10995 report report TX7994 10996 sialodochoplasty D7982 sialodochoplasty TX7995 10997 closure of salivary fistula D7983 closure of salivary fistula TX7996 emergency tracheotomy D7990 emergency tracheotomy TX7997 coronoidectomy D7991 coronoidectomy TX7998 surgical placement of craniofacial D7993 surgical placement of craniofacial TX7999 implant – extra oral implant – extra oral TX8010 surgical placement: zygomatic D7994 surgical placement: zygomatic TX8020 implant implant TX8030 synthetic graft - mandible or facial D7995 synthetic graft - mandible or facial TX8040 bones, by report bones, by report implant-mandible for D7996 implant-mandible for augmentation purposes augmentation purposes (excluding alveolar ridge), by (excluding alveolar ridge), by 10998 report report 10999 appliance removal (not by dentist D7997 appliance removal (not by dentist 11000 who placed appliance), includes who placed appliance), includes 11001 11002 removal of archbar removal of archbar 11003 11004 intraoral placement of a fixation D7998 intraoral placement of a fixation 11005 device not in conjunction with a device not in conjunction with a fracture fracture unspecified oral surgery D7999 unspecified oral surgery 238-71-99 procedure, by report procedure, by report limited orthodontic treatment of D8010 limited orthodontic treatment of the primary dentition the primary dentition limited orthodontic treatment of D8020 limited orthodontic treatment of the transitional dentition the transitional dentition limited orthodontic treatment of D8030 limited orthodontic treatment of the adolescent dentition the adolescent dentition limited orthodontic treatment of D8040 limited orthodontic treatment of the adult dentition the adult dentition Page 469

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX8050 11006 TX8060 interceptive orthodontic treatment D8050 interceptive orthodontic treatment of the primary dentition TX8070 of the primary dentition interceptive orthodontic treatment of the transitional dentition TX8080 interceptive orthodontic treatment D8060 TX8090 of the transitional dentition TX8210 11007 11008 comprehensive orthodontic D8070 comprehensive orthodontic treatment of the transitional D8080 treatment of the transitional 11009 dentition D8090 dentition 11010 comprehensive orthodontic D8210 comprehensive orthodontic treatment of the adolescent treatment of the adolescent dentition dentition 233-76-50 Minor treatment to control harmful comprehensive orthodontic comprehensive orthodontic habits - removable appliance treatment of the adult dentition treatment of the adult dentition therapy removable appliance therapy removable appliance therapy Minor treatment to control harmful habits - fixed appliance therapy 11011 TX8220 fixed appliance therapy D8220 fixed appliance therapy 233-76-51 11012 TX8660 pre-orthodontic treatment D8660 pre-orthodontic treatment TX8670 examination to monitor growth TX8680 examination to monitor growth and development TX8681 periodic orthodontic treatment visit 233-76-62 11013 TX8690 and development 11014 TX8695 TX8696 periodic orthodontic treatment visit D8670 Periodic orthodontic treatment visit 11015 orthodontic retention (removal of D8680 orthodontic retention (removal of 233-76-63 Orthodontic retention (removal of 11016 appliances, construction and appliances, construction and appliances, construction and placement of retainer(s)) placement of retainer(s)) placement of retainer(s)) removable orthodontic retainer D8681 removable orthodontic retainer adjustment adjustment orthodontic treatment (alternative D8690 orthodontic treatment (alternative billing to a contract fee) billing to a contract fee) 11017 11018 removal of fixed orthodontic D8695 removal of fixed orthodontic 11019 appliances for reasons other than appliances for reasons other than completion of treatment completion of treatment repair of orthodontic appliance – D8696 repair of orthodontic appliance – maxillary maxillary Page 470

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX8697 11020 TX8698 repair of orthodontic appliance – D8697 repair of orthodontic appliance – Unspecified orthodontic 11021 TX8699 procedure, by report 11022 TX8701 mandibular mandibular 11023 TX8702 11024 TX8703 re-cement or re-bond fixed D8698 re-cement or re-bond fixed 11025 TX8704 11026 TX8999 retainer – maxillary retainer – maxillary 11027 TX9110 11028 TX9120 re-cement or re-bond fixed D8699 re-cement or re-bond fixed 11029 TX9130 retainer – mandibular retainer – mandibular TX9210 repair of fixed retainer, includes D8701 repair of fixed retainer, includes TX9211 TX9212 reattachment – maxillary reattachment – maxillary TX9215 repair of fixed retainer, includes D8702 repair of fixed retainer, includes TX9219 reattachment – mandibular reattachment – mandibular TX9222 replacement of lost or broken D8703 replacement of lost or broken retainer – maxillary retainer – maxillary replacement of lost or broken D8704 replacement of lost or broken retainer – mandibular retainer – mandibular unspecified orthodontic D8999 unspecified orthodontic 233-76-99 procedure, by report procedure, by report palliative (emergency) treatment D9110 palliative (emergency) treatment of dental pain - minor procedure of dental pain - minor procedure fixed partial denture sectioning D9120 fixed partial denture sectioning temporomandibular joint D9130 temporomandibular joint dysfunction – non-invasive dysfunction – non-invasive 11030 physical therapies physical therapies local anesthesia not in D9210 local anesthesia not in conjunction with operative or conjunction with operative or 11031 surgical procedures surgical procedures 11032 regional block anesthesia D9211 regional block anesthesia 11033 trigeminal division block D9212 trigeminal division block anesthesia anesthesia local anesthesia in conjunction D9215 local anesthesia in conjunction with operative or surgical with operative or surgical 11034 procedures procedures evaluation for moderate sedation, D9219 evaluation for moderate sedation, deep sedation or general deep sedation or general 11035 anesthesia anesthesia 11036 deep sedation/general anesthesia D9222 deep sedation/general anesthesia – first 15 minutes – first 15 minutes Page 471

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX9223 deep sedation/general anesthesia D9223 deep sedation/general anesthesia Consultation - diagnostic service TX9230 provided by dentist or physician TX9239 – each subsequent 15 minute – each subsequent 15 minute other than requesting dentist or physician 11037 TX9243 increment increment 11038 TX9248 inhalation of nitrous D9230 inhalation of nitrous TX9310 oxide/analgesia, anxiolysis oxide/analgesia, anxiolysis TX9311 TX9410 intravenous moderate D9239 intravenous moderate TX9420 TX9430 (conscious) sedation/analgesia- (conscious) sedation/analgesia- 11039 TX9440 first 15 minutes first 15 minutes TX9450 TX9610 intravenous moderate D9243 intravenous moderate TX9612 (conscious) sedation/analgesia – (conscious) sedation/analgesia – each subsequent 15 minute each subsequent 15 minute 11040 increment increment 11041 non-intravenous conscious D9248 non-intravenous conscious sedation sedation consultation - diagnostic service D9310 consultation - diagnostic service 233-99-20 provided by dentist or physician provided by dentist or physician other than requesting dentist or other than requesting dentist or 11042 physician physician 11043 consultation with a medical health D9311 consultation with a medical health 11044 care professional care professional 11045 house/extended care facility call D9410 house/extended care facility call hospital or ambulatory surgical D9420 hospital or ambulatory surgical center call center call office visit for observation (during D9430 office visit for observation (during regularly scheduled hours) - no regularly scheduled hours) - no other services performed other services performed 11046 office visit - after regularly D9440 office visit - after regularly 11047 scheduled hours 11048 scheduled hours case presentation, detailed and 11049 extensive treatment planning case presentation, detailed and D9450 therapeutic parenteral drug, 11050 single administration extensive treatment planning therapeutic parenteral drugs, two or more administrations, different therapeutic parenteral drug, D9610 medications single administration therapeutic parenteral drugs, two D9612 or more administrations, different medications Page 472

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX9613 infiltration of sustained release D9613 infiltration of sustained release TX9630 therapeutic drug – single or therapeutic drug – single or multiple sites TX9910 drugs or medicaments dispensed 11051 TX9911 multiple sites in the office for home use TX9920 drugs or medicaments dispensed D9630 TX9930 in the office for home use TX9932 11052 application of desensitizing D9910 application of desensitizing 11053 TX9933 medicament medicament application of desensitizing resin D9911 application of desensitizing resin 11054 TX9934 for cervical and/or root surface, for cervical and/or root surface, 11055 per tooth per tooth TX9935 behavior management, by report D9920 behavior management, by report TX9941 treatment of complications (post- D9930 treatment of complications (post- TX9942 surgical) - unusual TX9943 surgical) - unusual circumstances, by report TX9944 cleaning and inspection of 11056 TX9945 circumstances, by report removable complete denture, maxillary cleaning and inspection of D9932 cleaning and inspection of removable complete denture, removable complete denture, mandibular cleaning and inspection of 11057 maxillary removable partial denture, maxillary cleaning and inspection of D9933 cleaning and inspection of removable partial denture, removable complete denture, mandibular fabrication of athletic mouthguard 11058 mandibular cleaning and inspection of D9934 removable partial denture, 11059 maxillary cleaning and inspection of D9935 removable partial denture, 11060 mandibular 11061 11062 fabrication of athletic mouthguard D9941 Fabrication of athletic mouthguard 11063 11064 repair and/or reline of occlusal D9942 repair and/or reline of occlusal 11065 guard guard occlusal guard adjustment occlusal guard – hard appliance, occlusal guard adjustment D9943 full arch occlusal guard – soft appliance, occlusal guard – hard appliance, D9944 full arch full arch occlusal guard – soft appliance, D9945 full arch Page 473

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX9946 11066 occlusal guard – hard appliance, D9946 occlusal guard – hard appliance, Occlusion analysis - mounted TX9950 case 11067 partial arch partial arch Occlusal adjustment - limited 11068 TX9951 Occlusal adjustment - complete 11069 TX9952 occlusion analysis - mounted case D9950 occlusion analysis - mounted case 233-99-10 11070 TX9961 Enamel microabrasion 11071 TX9970 occlusal adjustment - limited D9951 occlusal adjustment - limited 233-99-13 Odontoplasty 1-2 teeth; includes TX9971 occlusal adjustment - complete D9952 occlusal adjustment - complete 233-99-14 removal of enamel projections duplicate/copy patient's records D9961 duplicate/copy patient's records enamel microabrasion D9970 enamel microabrasion 238-71-S6 odontoplasty - per tooth D9971 odontoplasty - per tooth 238-71-S5 11072 TX9972 external bleaching - per arch - D9972 external bleaching - per arch - 238-71-T1 Bleaching of discolored tooth, TX9973 performed in office vital -chair side 11073 TX9974 performed in office external bleaching - per tooth 11074 TX9975 internal bleaching - per tooth Bleaching of discolored tooth, 11075 external bleaching - per tooth D9973 external bleaching for home 238-71-T2 vital -home TX9985 application, per arch; includes TX9986 internal bleaching - per tooth D9974 materials and fabrication of TX9987 custom trays TX9990 external bleaching for home D9975 sales tax TX9991 missed appointment application, per arch; includes cancelled appointment TX9992 certified translation or sign- TX9993 materials and fabrication of language services – per visit TX9994 dental case management - 11076 custom trays addressing appointment 11077 TX9995 compliance barriers 11078 sales tax D9985 dental case management - care 11079 coordination 11080 missed appointment D9986 dental case management - motivational interviewing 11081 cancelled appointment D9987 dental case management - 11082 patient education to improve oral 11083 certified translation or sign- D9990 health literacy teledentistry – synchronous; real- 11084 language services – per visit time encounter 11085 dental case management - D9991 addressing appointment compliance barriers dental case management - care D9992 coordination dental case management - D9993 motivational interviewing dental case management - D9994 patient education to improve oral health literacy teledentistry – synchronous; real- D9995 time encounter Page 474

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term TX9996 teledentistry – asynchronous; D9996 teledentistry – asynchronous; information stored and forwarded information stored and forwarded to dentist for subsequent review to dentist for subsequent review 11086 TX9997 dental case management - D9997 dental case management - patients with special health care 11087 TX9999 patients with special health care needs unspecified adjunctive 11088 OPDX012391-phy needs procedure, by report 11089 OPTX8210-ins unspecified adjunctive D9999 233-99-99 Unspecified dental procedure, by 11090 OPTX8210-adj report procedure, by report 11091 OPTX2740-zir Physiologic root resorption 11092 OPTX171548-gi 11093 OPTX171548-tem Removable appliance therapy- 11094 OPTX1208-sf 11095 OPTX8220-ins insertion 11096 OPTX8220-adj 11097 OPDX207267-ort Removable appliance therapy- 11098 OPDX0470-ort adjust 11099 OP179862-ts Crown-porcelain/ceramic 11100 OP130999-ex substance - zirconia 11101 OP130999-fa GI filling 11102 OP147853-ddx Temporary filling 11103 OP171229-ddx 11104 OP112717-ddx* Silver diamine fluoride 11105 Fixed appliance therapy-insertion Fixed appliance therapy-adjust History and physical examination, monitoring (regime/therapy) - orthodontics Diagnostic cast (พิมพ์ปากเพอ่ื วาง แผนการรักษาจดั ฟัน) Prescription of service (procedure) - Tooth separation Orthodontic appliance, device (physical object) - extra-oral appliance Orthodontic appliance, device (physical object) - functional appliance Apthous-like ulcer-ddx Chronic granulomatous disease Lymphoma-ddx Page 475

A B C D EF G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term 11106 OP119804010-ddx** Vestibullobulbous disease-ddx 11107 11108 OP19195028-isa Folate deficiency anemia 11109 OP0482-refer Direct immunofluorescence-refer 11110 OP0483-refer Indirect immunofluorescence 11111 11112 OP176504-pt Patient reassurance and 11113 counselling for the control 11114 11115 OP5991 Prefabricated splint for topical 11116 11117 drug delivery 11118 11119 OP168984-remove Surgical suture removal 11120 11121 OP168984-stcoff Stitch off 11122 11123 OP121901-apical Apical abscess with sinus 11124 11125 opening 11126 11127 OP5984280027-isa Perforation/Broken instrument 11128 OP140805 Crown-root fracture 11129 OP127481 Root fracture 11130 OP114634 Attrition 11131 11132 OP504947013 Erosion 11133 11134 OP475319012 Hypersensitive Dentin 11135 OP3110 Vital pulp therapy OP109579 Periodontal abscess with sinus OP190586 Healthy Implant OP161301-up Impacted tooth (upper) OP161301-lo Impacted tooth (lower) OP190777 Implant failures OP0170-cd Change drain OP0171-fu Follow up (surgery) OP176694-negroom negative pressure - transfer(condition?) OP176710-systemic systemic disease with special managenent (condition?) OP176710- pre-operative preparation for preop_GA general anesthesia (condition?) OP176694-scope Microscope -transfer(condition?) OP189010 Edentulous area OP2985592010 Median diastema OP2985592010- Spacing 1 area (not median other diastema) Page 476

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP189010-pmiss 11136 OP189010-tmiss Partial missing 11137 OP207187 Total missing 11138 OP178094 Endodontically treated teeth 11139 OP179022 Improper denture 11140 OP179051 Deep pit and fissure 11141 OP0601 High caries risk 11142 OPK00.11 caries risk assessment ********* Premolar region (อยภู่ ายใต้ 11143 OPK00.12 K00.1-supernumerary teeth) Molar region (อยภู่ ายใต้ 11144 OPK01.10 K00.1-supernumerary teeth) Maxillary incisor (อยภู่ ายใต้ 11145 OPK01.11 K01.1-Impacted teeth) Mandibular incisor (อยภู่ ายใต้ 11146 OPK01.12 K01.1-Impacted teeth) Maxillary canine (อยภู่ ายใต้ 11147 OPK01.13 K01.1-Impacted teeth) Mandibular canine (อยภู่ ายใต้ 11148 OPK01.14 K01.1-Impacted teeth) Maxillary premolar (อยภู่ ายใต้ 11149 OPK01.15 K01.1-Impacted teeth) Mandibular premolar (อยภู่ ายใต้ 11150 OPK01.16 K01.1-Impacted teeth) Maxillary molar (อยภู่ ายใต้ 11151 OPK01.17 K01.1-Impacted teeth) OPK02.4 Mandibular molar (อยภู่ ายใต้ 11152 OPK02.8 K01.1-Impacted teeth) 11153 OPK03.08 Odontoclasia 11154 OPK03.09 Other dental caries 11155 OPK03.18 Other specified attrition of teeth 11156 OPK03.3 Attrition of teeth\\, unspecified 11157 OPK04.08 Other specified abrasion of teeth 11158 OPK04.62 Pathological resorption of teeth 11159 OPK04.69 Other specified pulpitis 11160 Sinus to oral cavity Periapical abscess with 11161 sinus,unspecified Page 477

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OPK04.80 Apical and lateral radicular cyst 11162 OPK04.89 Radicular cyst, unspecified 11163 OPK05.00 Acute streptococcal gingivostomatitis 11164 OPK05.08 Other specified acute gingivitis 11165 OPK05.09 Acute gingivitis,unspecified 11166 OPK05.18 Other specified chronic gingivitis 11167 OPK05.19 Chronic gingivitis,unspecified 11168 OPK05.21 Periodontal abscess with sinus 11169 OPK05.28 Other specified acute periodontitis 11170 OPK05.30 Simplex 11171 OPK05.31 Complex 11172 OPK05.33 Thickened follicle 11173 OPK05.38 Other specified chronic periodontitis 11174 OPK05.39 Chronic periodontitis, unspecified 11175 OPK05.5 Other periodontal diseases 11176 OPK05.6 Periodontal disease, unspecified 11177 OPK06.09 Gingival recession, unspecified 11178 OPK06.18 Other specified gingival enlargement 11179 OPK06.2 Gingival and edentulous alveolar ridge lesions 11180 OPK06.20 associated with trauma 11181 OPK06.21 Due to traumatic occlusion 11182 OPK06.22 Due to toothbrushing 11183 Frictional keratosis OPK06.23 Irritative hyperplasia (denture 11184 hyperplasia) OPK06.29 Gingival and edentulous ridge 11185 lesions associated with trauma, unspecified Page 478

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OPK06.88 11186 Other specified disorders of OPK06.9 gingival and edentulous alveolat 11187 ridge (fibrous epulis flabby ridge 11188 OPK07.08 ,giant cell epulis ,peripheral giant 11189 OPK07.09 cell granuloma of gingival) 11190 OPK07.24 Exfoliation of teeth due to 11191 OPK07.25 systemic causes 11192 OPK07.28 Disorder of gingiva and 11193 OPK07.29 edentulous alveolar ridge, 11194 OPK07.33 unspecified 11195 OPK07.35 Other specified major anomalies 11196 OPK07.38 of jaw size 11197 OPK07.55 Anomaly of jaw size, unspecified 11198 OPK07.58 Openbites 11199 OPK07.59 Crossbite (anterior) (posterior) 11200 OPK07.63 Other specified anomalies of 11201 OPK07.69 dental arch relationship OPK08.1 Anomaly of dental arch 11202 relationship, unspecified Spacing Embedded or impacted teeth with abnormal position Other specified anomalies of tooth position Malocclusion due to tongue, lip or finger habits Other specified dentofacial functional abnormalities Dentofacial abnormality, unspecified Pain in temporomandibular joint, not elsewhere classified Temporomandibular joint disorder, unspecified Loss of teeth due to accident, extraction or local periodontal disease Page 479

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OPK09.02 Keratocyst [primordial] 11203 OPK10.08 Other specified developmental disorders of jaws 11204 OPK10.20 Osteitis of jaw 11205 OPK10.29 Inflammatory condition of jaws, unspecified 11206 OPK10.88 Other specified diseases of jaws 11207 OPK11.9 Disease of salivary gland, unspecified 11208 OPK13.1 Cheek and lip biting 11209 OPK13.40 Granuloma and granuloma‐like lesions of mucosa (pyogenic 11210 OPK14.41 granuloma , verrucous xanthoma) 11211 OPL81.2 Atrophy of tongue papillae due to 11212 OPL81.8 systemic Freckles 11213 OPM79.0 Other specified disorders of 11214 OPQ11.0 pigmentation 11215 OPQ11.2 Rheumatism, unspecified 11216 OPQ35.6 Cystic eyeball 11217 OPQ35.8 Microphthalmos 11218 OPQ35.9 Cleft palate, medial 11219 OPQ36.9 Cleft palate, unspecified, bilateral 11220 OPQ37.1 Cleft palate, unspecified Cleft lip, unilateral 11221 OPQ37.2 Cleft hard palate with unilateral cleft lip 11222 OPQ37.3 Cleft soft palate with bilateral cleft lip 11223 OPQ37.4 Cleft soft palate with unilateral cleft lip 11224 OPQ37.5 Cleft hard and soft palate with bilateral cleft lip 11225 Cleft hard and soft palate with unilateral cleft lip Page 480

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OPQ37.8 11226 Unspecified cleft palate with OPQ37.9 bilateral cleft lip 11227 Unspecified cleft palate with Q67.49 unilateral cleft lip 11228 Congenital deformity of skull, face 11229 OPR25.2 and jaw, unspecified OPS02.40 Cramp and spasm 11230 Fracture of malar, maxillary and OPS02.500 zygoma bones, unspecified 11231 Closed fracture of enamel of tooth OPS02.501 only 11232 Closed fracture of crown of 11233 OPS02.502 tooth without pulpal involvement 11234 OPS02.503 Closed fracture of crown OPS02.504 Closed fracture of root of tooth 11235 Closed fracture of crown with 11236 OPS02.507 fracture of root of tooth 11237 OPS02.507 Mutiple closed fractures of teeth OPS02.510 Mutiple closed fractures of teeth 11238 Open Fracture of enamel of tooth OPS02.511 only 11239 OPS02.513 Open Fracture of crown of tooth 11240 OPS02.53 without pulpal involvement 11241 OPS02.70A Open fracture of root of tooth Fracture of root of tooth 11242 OPS02.64 Fracture of mandibular alveolar 11243 OPS02. 66XA process 11244 OPS03.20 Fracture of ramus 11245 OPS03.21 Fracture of symphysis 11246 OP233-00-31 Luxation of tooth Intrusion or extrusion of tooth 11247 OP233-00-99 Diagnostic intraoral and extraoral images 11248 OP225-04-00 Unspecified oral evaluation, by 11249 OP225-11-70 report 11250 Biopsy of lip Removal of suture from lip Page 481

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP225-26-70 Debridement of lip 11251 OP225-26-71 Excision of lesion of lip 11252 OP225-39-70 Suture of laceration of lip 11253 OP225-99-99 Other procedures and operations on lips 11254 OP233-04-00 Biopsy of mouth 11255 OP233-11-70 Removal of suture from mouth 11256 OP233-11-71 Removal of foreign body from mouth without incision 11257 OP233-22-00 Drainage of mouth (Include: Incision and drainage) 11258 OP233-26-70 Debridement of mouth 11259 OP233-26-71 Excision of lesion of mouth 11260 OP233-28-70 Destruction of lesion of mouth 11261 OP233-39-70 Suture of laceration of mouth 11262 OP233-80-70 Wound dressing at mouth 11263 OP233-83-70 Irrigation of mouth 11264 OP236-04-00 Biopsy of gum 11265 OP236-04-01 Biopsy of alveoli 11266 OP236-04-99 Other diagnostic procedure on gums and alveoli 11267 OP236-21-00 Incision of gum or alveolar bone, Apical alveolotomy 11268 OP236-26-00 Excision of lesion or tissue of gum 11269 OP236-39-00 Suture of laceration of gum 11270 OP236-48-00 Gingivoplasty, Gingivoplasty with bone or soft tiisue graft 11271 OP236-99-99 Other procedures and operation on gum 11272 OP238-11-00 Removal of dental packing 11273 OP238-11-01 Removal of dental wiring 11274 OP238-12-00 Replacement of dental packing 11275 OP238-12-01 Replacement of dental wiring 11276 OP238-99-99 Other procedures and operations on teeth 11277 Page 482

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP105-05-02 11278 OP161-05-02 Postero-anterior or lateral skull 11279 OP237-05-00 and facial bone survey film Cephalometric film 11280 OP238-05-00 Intraoral periapical film including periapical and bitewing view 11281 OP233-05-02 (Child/Primary) 11282 OP233-86-11 Intraoral periapical film including periapical and bitewing view 11283 OP233-70-10 (Adult/Permanent) 11284 OP237-70-20 Other intraoral films, by report 11285 OP238-70-20 Oral hygiene instruction in 11286 OP237-70-21 conjunction with periodontic treatment 11287 OP238-70-21 Oral administration of fluoride tablet for preventive purpose 11288 OP237-70-30 Topical application of fluoride 11289 OP238-70-30 (Child/Primary) 11290 OP237-70-40 Topical application of fluoride 11291 OP238-70-40 (Adult/Permanent) 11292 OP237-71-A1 Topical application of fluoride, 11293 OP237-71-A2 including prophylaxis 11294 (Child/Primary) Topical application of fluoride, including prophylaxis (Adult/Permanent) Sealant per tooth (Child/Primary) Sealant per tooth (Adult/Permanent) Preventive resin restoration (Child/Primary) Preventive resin restoration (Adult/Permanent) Amalgam 1 surface (Child/Primary) Amalgam 2 surfaces (Child/Primary) Page 483

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP237-71-A3 11295 OP237-71-A4 Amalgam 3 surfaces 11296 OP238-71-A1 (Child/Primary) 11297 OP238-71-A2 Amalgam 4 surfaces or more 11298 OP238-71-A3 (Child/Primary) 11299 OP238-71-A4 Amalgam 1 surface 11300 OP237-71-B1 (Adult/Permanent) Amalgam 2 surfaces 11301 OP237-71-B2 (Adult/Permanent) Amalgam 3 surfaces 11302 OP237-71-B3 (Adult/Permanent) Amalgam 4 surfaces or more 11303 OP237-71-B4 (Adult/Permanent) Resin-based composite 11304 OP237-71-B5 restorations - Anterior teeth 1 surface (Child/Primary) 11305 OP238-71-B1 Resin-based composite restorations - Anterior teeth 2 11306 OP238-71-B2 surfaces (Child/Primary) Resin-based composite 11307 OP238-71-B3 restorations - Anterior teeth 3 surfaces (Child/Primary) 11308 Resin-based composite restorations - Anterior teeth 4 surfaces or more (Child/Primary) Resin-based composite restorations - Anterior teeth crown (Child/Primary) Resin-based composite restorations - Anterior teeth 1 surface (Adult/Permanent) Resin-based composite restorations - Anterior teeth 2 surfaces (Adult/Permanent) Resin-based composite restorations - Anterior teeth 3 surfaces (Adult/Permanent) Page 484

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP238-71-B4 11309 Resin-based composite 11310 OP238-71-B5 restorations - Anterior teeth 4 11311 surfaces or more 11312 OP237-71-C1 (Adult/Permanent) 11313 Resin-based composite 11314 OP237-71-C2 restorations - Anterior teeth crown 11315 (Adult/Permanent) 11316 OP237-71-C3 Resin-based composite 11317 restorations - Posterior teeth 1 OP237-71-C4 surface (Child/Primary) 11318 Resin-based composite 11319 OP238-71-C1 restorations - Posterior teeth 2 surfaces (Child/Primary) 11320 OP238-71-C2 Resin-based composite 11321 restorations -Posterior teeth 3 11322 OP238-71-C3 surfaces (Child/Primary) Resin-based composite OP238-71-C4 restorations - Posterior teeth 4 surfaces or more (Child/Primary) OP238-71-M4 Resin-based composite OP238-71-N4 restorations - Posterior teeth 1 OP238-71-R1 surface (Adult/Permanent) OP238-71-R5 Resin-based composite restorations - Posterior teeth 2 surfaces (Adult/Permanent) Resin-based composite restorations - Posterior teeth 3 surfaces (Adult/Permanent) Resin-based composite restorations - Posterior teeth 4 surfaces or more (Adult/Permanent) Crown resin, laboratory Crown porcelain/ceramic substrate Crown removal Crown repair, by report Page 485

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP238-71-S1 Canal preparation and fitting of 11323 OP238-71-S8 preformed dowel or post Tooth preparation and other steps 11324 OP238-71-T3 in the process of inlay/onlay, post 11325 OP238-71-U1 and core, crown, and labial 11326 OP238-71-U2 veneer 11327 OP238-71-79 Bleaching of discolored tooth, 11328 OP237-72-10 non-vital 11329 OP238-72-13 Sedative filling 11330 OP237-72-11 Temporary crown/band (fractured 11331 OP238-72-14 tooth) 11332 OP237-72-12 Tooth filling, unspecified 11333 OP237-72-20 Therapeutic pulpotomy (Child/Primary) 11334 OP237-72-21 Therapeutic pulpotomy 11335 (Adult/Permanent) OP237-72-22 Gross pulpal debridement 11336 (Child/Primary) 11337 OP237-72-23 Gross pulpal debridement (Adult/Permanent) Therapeutic partial pulpotomy (Adult/Permanent) Pulp therapy (Resorbable filling) : Pulpectomy- Anterior teeth, First and other visits Pulp therapy (Resorbable filling) : Pulpectomy - Anterior teeth, Root filled visits Pulp therapy (Resorbable filling) : Pulpectomy - Posterior teeth, First and other visits Pulp therapy (Resorbable filling) : Pulpectomy - Posterior teeth, Root filled visits Page 486

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP238-72-20 11338 Endodontic therapy - IR, MI 11339 OP238-72-21 (Anterior) 11340 Endodontic therapy - IR, MI 11341 OP238-72-22 (Bicuspid) 11342 Endodontic therapy - IR, MI 11343 OP238-72-23 (Molar) 11344 Endodontic therapy - root-filled 11345 OP238-72-24 visit (Anterior) 11346 Endodontic therapy - root-filled 11347 OP238-72-25 visit (Bicuspid) 11348 Endodontic therapy - root-filled 11349 OP238-72-26 visit (Molar) 11350 Endodontic therapy - One visit 11351 OP238-72-27 (Anterior) 11352 Endodontic therapy - One visit 11353 OP238-72-28 (Bicuspid) 11354 Endodontic therapy - One visit 11355 OP238-72-40 (Molar) OP238-72-41 Retreatment - IR, MI (Anterior) OP238-72-42 Retreatment - IR, MI (Bicuspid) OP238-72-43 Retreatment - IR, MI (Molar) Retreatment - root-filled visit OP238-72-44 (Anterior) Retreatment - root-filled visit OP238-72-40 (Bicuspid) Retreatment - root-filled visit OP238-72-60 (Molar) Apicoectomy/Periradicular OP238-72-61 surgery - Anterior, 1 Tooth Apicoectomy/Periradicular OP238-72-62 surgery - Anterior, 2 Teeth Apicoectomy/Periradicular OP238-72-63 surgery - Anterior, 3 Teeth Apicoectomy/Periradicular surgery - Anterior, 4 or more Teeth 11356 Page 487

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP238-72-64 11357 Apicoectomy/Periradicular OP238-72-65 surgery - Bicuspid, 1 root 11358 Apicoectomy/Periradicular OP238-72-66 surgery - Bicuspid, 2 roots 11359 Apicoectomy/Periradicular OP238-72-67 surgery - Molar, 1 root 11360 Apicoectomy/Periradicular OP238-72-68 surgery - Molar, 2 roots 11361 Apicoectomy/Periradicular 11362 OP238-72-70 surgery - Molar, 3 roots 11363 OP238-72-71 Retrograde filling 1 root 11364 OP238-72-72 Retrograde filling 2 roots 11365 OP238-72-73 Retrograde filling 3 roots 11366 OP238-72-80 Retrograde filling 4 roots OP238-72-81 Root amputation 1 root 11367 Root amputation 1 root without 11368 OP238-72-83 mucoperiosteal flap OP238-72-84 Root amputation 2 roots 11369 Root amputation 2 roots without 11370 OP238-72-79 mucoperiosteal flap OP227-73-10 Root canal therapy, unspecified 11371 Periodontal debridement - upper OP228-73-10 arch 11372 Periodontal debridement - lower OP227-73-20 arch 11373 Periodontal maintenance OP228-73-20 procedures, following active 11374 therapy - upper arch OP228-73-30 Periodontal maintenance procedures, following active 11375 therapy - lower arch Periodontal maintenance procedures, following active therapy - full mouth Page 488

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP236-73-10 Debridement to enable 11376 comprehensive periodontal 11377 OP236-73-20 evaluation and diagnosis –full 11378 OP236-73-50 arch 11379 OP236-73-51 Periodontal scaling and planning 11380 OP236-73-52 –per quadrant 11381 OP236-73-52 Gingivectomy or gingivoplasty OP236-73-53 per tooth 11382 Gingivectomy or gingivoplasty 11383 OP236-73-55 per quadrant 11384 OP236-73-61 Gingival curettage, surgical –per 11385 OP236-73-62 quadrant, by report OP236-73-72 Gingival curettage, surgical –per 11386 quadrant, by report 11387 OP236-73-88 Gingival flap procedure, including OP227-74-22 root planing –per quadrant 11388 OP228-74-22 Distal or proximal wedge 11389 procedure 11390 OP228-74-23 Coronal positioned flap 11391 OP238-74-10 Semilunar flap Subepithelial connective tissue graft procedure –including donor site surgery Periodontal surgery: post- operative preocedure Metallic Partial denture with precision attachment - Upper arch Metallic Partial denture with precision attachment - Lower arch Swinglock partial denture - Upper arch Removable bridge Page 489

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP227-74-32 11392 Modification of removable OP228-74-32 prosthesis following implant 11393 surgery - Upper arch 11394 OP227-74-40 Modification of removable 11395 OP227-74-41 prosthesis following implant 11396 OP228-74-41 surgery - Lower arch 11397 OP227-74-42 Repair broken complete denture 11398 OP228-74-42 base 11399 OP227-74-43 Repair resin denture base - 11400 OP228-74-43 Upper arch 11401 OP227-74-44 Repair resin denture base - Lower 11402 OP228-74-44 arch 11403 OP227-74-45 Repair cast framework - Upper 11404 OP228-74-45 arch 11405 OP227-74-46 Repair cast framework -Lower 11406 OP228-74-46 arch OP227-74-47 Repair or replace broken clasp - Upper arch 11407 Repair or replace broken clasp - Lower arch Replace broken or worn teeth - Upper arch Replace broken or worn teeth - Lower arch Add tooth to existing partial denture - Upper arch Add tooth to existing partial denture - Lower arch Add clasp to existing partial denture - Upper arch Add clasp to existing partial denture - Lower arch Replacement of replaceable part of semi-precision or precision attachment, male or female component - Upper arch Page 490

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP228-74-47 Replacement of replaceable part 11408 of semi-precision or precision 11409 OP227-74-72 attachment, male or female 11410 OP228-74-72 component - Lower arch 11411 OP227-74-73 Tissue conditioning –complete 11412 OP228-74-73 denture - Upper arch 11413 OP238-74-G1 Tissue conditioning –complete 11414 OP238-74-G2 denture - Lower arch 11415 OP238-74-G3 Tissue conditioning –partial 11416 OP238-74-G4 denture - Upper arch 11417 OP238-74-H5 Tissue conditioning –partial 11418 OP238-74-N1 denture - Lower arch OP238-74-P1 Inlay Metallic – 2 surfaces 11419 Inlay Metallic – 3 or more surfaces 11420 OP238-74-P2 11421 OP238-74-Q1 Onlay Metallic – 2 surfaces 11422 OP238-74-Q2 Onlay Metallic – 3 or more 11423 OP238-74-Q3 surfaces 11424 OP238-74-R1 Inlay/Onlay - 11425 OP238-74-R2 Porcelain/Ceramic 11426 OP238-74-V2 Core build up for retainer, including any pins Prefabricated post and core in addition to fixed partial denture retainer Each additional prefabricated post –same tooth Each post as part of fixed partial denture retainer Each post and core in addition to fixed partial denture retainer Each additional cast post –same tooth Coping - Metal Coping - Filling material Fixed partial denture repair, by report Page 491

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP238-74-V3 Removal of fixed partial denture 11427 OP159-74-30 Surgical stent - Upper arch 11428 OP160-74-30 Surgical stent - Lower arch 11429 OP159-74-31 Surgical splint - Upper arch 11430 OP160-74-30 Surgical splint - Lower arch 11431 OP154-75-10 Surgical placement of craniofacial (osseointegrated) 11432 OP177-75-10 implant for anchoring of facial prosthesis 11433 OP178-75-10 Surgical placement of craniofacial (osseointegrated) 11434 OP185-75-10 implant for anchoring of orbital (eye) prosthesis 11435 OP154-75-20 Surgical placement of 11436 craniofacial (osseointegrated) OP177-75-20 implant for anchoring of ear 11437 prosthesis 11438 OP178-75-20 Surgical placement of 11439 craniofacial (osseointegrated) 11440 OP185-75-20 implant for anchoring of nose prosthesis OP233-75-11 Prosthesis stage of craniofacial (osseointegrated) implant for facial prosthesis Prosthesis stage of craniofacial (osseointegrated) implant for orbital (eye) prosthesis Prosthesis stage of craniofacial (osseointegrated) implant for ear prosthesis Prosthesis stage of craniofacial (osseointegrated) implant for nose prosthesis Surgical placement of healing cap: endosteal implant Page 492

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP233-75-12 Surgical placement of implant 11441 body and healing cap: endosteal OP233-75-13 implant 11442 OP233-75-16 Abutment placement or 11443 OP233-75-19 substitution: endosteal implant OP233-75-50 Implant removal, by report 11444 Other surgical technique for OP233-75-50 implant, by report 11445 Implant/abutment supported fixed OP233-76-10 denture for completely 11446 OP233-76-11 edentulous arch 11447 OP233-76-20 Implant/abutment supported fixed 11448 denture for partially edentulous OP233-76-21 arch 11449 Limited orthodontic treatment - OP233-76-30 Removable appliance therapy 11450 Limited orthodontic treatment - OP233-76-31 Partial fixed appliance therapy 11451 Interceptive orthodontic treatment OP233-76-32 - Removable appliance therapy 11452 OP233-76-33 Interceptive orthodontic treatmen - 11453 Partial fixed appliance therapy 11454 Comprehensive orthodontic treatment - Removable appliance therapy Comprehensive orthodontic treatment - Partial fixed appliance therapy Comprehensive orthodontic treatment - Simple full fixed appliance therapy Comprehensive orthodontic treatment - Complex full fixed appliance therapy Page 493

A B C D E F G H I J 1 SNODENT ID SNODENT TERM SYNONYM ID SYNONYM TERM SD ID SD TERM CDT ID CDT TERM ICD-10 TM ID ICD-10 TM Term OP233-76-34 11455 Comprehensive orthodontic 233-76-60 treatment - Orthognatic surgery 11456 therapy 11457 OP233-76-61 Analysis of model, cephalogram 11458 OP233-76-64 or growth forecast and treatment 11459 OP233-76-65 prediction OP233-76-66 Pre-orthodontic treatment visit 11460 OP233-76-67 Orthodontic treatment (referred) 11461 OP154-99-10 Repair of orthodontic appliance Replacement of lost or broken 11462 OP154-99-11 retainer Setup model 11463 OP154-99-98 Oro-facial pain - Non-surgical 11464 OP162-99-10 treatments e.g.; physiotherapy, jaw exercise, occlusal splint, 11465 OP233-99-11 acupuncture medication 11466 OP233-99-15 Oro-facial pain - Surgical treatments e.g.; alcohol injection 11467 to the nerves involved, cryosurgery, laser surgery Oro-facial pain - Other treatments, non-specified Oro-facial pain and TMJ services - Non-surgical treatment e.g.; physiotherapy, jaw exercise, occlusal splint, acupuncture thermal, ultrasound and medication Occlusal guard, by report Palliative/emergency treatment of dental pain – minor procedure (open and drain) Page 494