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APPENDIX B <br />CODE ON DENTAL PROCEDURES AND NOMENCLATURE <br />NOTE: All the listed procedures may not be benefits under the terms of your contract. Refer to your <br />contract for your specific benefits. <br />D0100 - D0999 DIAGNOSTIC <br />Clinical oral evaluations <br />D0120 Periodic oral evaluation - established patient <br />D0140 Limited oral evaluation - problem focused <br />D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver <br />D0150 Comprehensive oral evaluation - new or established patient <br />D0160 Detailed and extensive oral evaluation - problem focused, by report <br />D0170 Re-evaluation - limited, problem focused (established patient; not post-operative visit) <br />D0180 Comprehensive periodontal evaluation - new or established patient <br />Radiographs/diagnostic imaging (including interpretation) <br />D0210 Intraoral - complete series (including bitewings) <br />D0220 Intraoral - periapical first film <br />D0230 Intraoral - periapical each additional film <br />D0240 Intraoral - occlusal film <br />D0250 Extraoral - first film <br />D0260 Extraoral - each additional film <br />D0270 Bitewing - single film <br />D0272 Bitewings - two films <br />D0273 Bitewings - three films <br />D0274 Bitewings - four films <br />D0277 Vertical bitewings - 7 to 8 films <br />D0290 Posterior - anterior or lateral skull and facial bone survey film <br />D0310 Sialography <br />D0320 Temporomandibular joint arthrogram, including injection <br />D0321 Other temporomandibular joint films, by report <br />D0322 Tomographic survey <br />D0330 Panoramic film <br />D0340 Cephalometric film <br />D0350 Oral/facial photographic images <br />D0360 Cone beam ct - craniofacial data capture <br />D0362 Cone beam - two-dimensional image reconstruction using existing data, includes <br />images <br />D0363 Cone beam - three-dimensional image reconstruction using existing data, includes <br />images <br />multiple <br />multiple <br />Tests and examinations <br />D0415 Collection of microorganisms for culture and sensitivity <br />D0416 Viral culture <br />D0421 Genetic test for susceptibility to oral diseases <br />D0425 Caries susceptibility tests <br />D0431 Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including <br />premalignant and malignant lesions, not to include cytology or biopsy procedures <br />D0460 Pulp vitality tests <br />D0470 Diagnostic casts