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EMPLOYEE GROUP INS. RENEWALS -2012
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EMPLOYEE GROUP INS. RENEWALS -2012
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Last modified
2/16/2017 12:29:05 PM
Creation date
7/12/2013 10:31:02 AM
Metadata
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Contracts
Company Name
EMPLOYEE GROUP INS. RENEWALS
Contract #
A-2012-170
Agency
PERSONNEL SERVICES
Council Approval Date
8/6/2012
Expiration Date
12/13/2013
Destruction Year
2018
Notes
Amends A-2002-208 Amended by A-2014-176, A-2015-206, A-2015-207
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Apexification/ recalcification procedures <br />D3351 Apexification/recalcification/pupa) regeneration - initial visit (apical closure/calcific repair <br />of perforations, root resorption, pulp space disinfection, etc.) <br />D3352 Apexification/recalcification/pulpal regeneration - interim medication replacement (apical <br />closure/calcific repair of perforations, root resorption, pulpal space disinfection, etc.) <br />D3353 Apexification/recalcification - final visit (includes completed root canal therapy - apical <br />closure/calcific repair of perforations, root resorption, etc.) <br />Apicoectomy/periradicular services <br />D3410 Apicoectomy/periradicular surgery - anterior <br />D3421 Apicoectomy/periradicular surgery - bicuspid (first root) <br />D3425 Apicoectomy/periradicular surgery - molar (first root) <br />D3426 Apicoectomy/periradicular surgery (each additional root) <br />D3430 Retrograde filling - per root <br />D3450 Root amputation - per root <br />D3460 Endodontic endosseous implant <br />D3470 Intentional reimplantation (including necessary splinting) <br />Other endodontic procedures <br />D3910 Surgical procedure for isolation of tooth with rubber dam <br />D3920 Hemisection (including any root removal), not including root canal therapy <br />D3950 Canal preparation and fitting of preformed dowel or post <br />D3999 Unspecified endodontic procedure, by report <br />D4000 - D4999 PERIODONTICS <br />Surgical services (including usual post-operative care) <br />D4210 Gingivectomy or gingivoplasty - four or more contiguous teeth or bounded teeth spaces <br />per quadrant <br />D4211 Gingivectomy or gingivoplasty - one to three contiguous teeth or bounded teeth spaces per <br />quadrant <br />D4230 Anatomical crown exposure - four or more contiguous teeth per quadrant <br />D4231 Anatomical crown exposure - one to three teeth per quadrant <br />D4240 Gingival flap procedure, including root planing - four or more contiguous teeth or bounded <br />teeth spaces per quadrant <br />D4241 Gingival flap procedure, including root planing - one to three contiguous teeth or bounded <br />teeth spaces per quadrant <br />D4245 Apically positioned flap <br />D4249 Clinical crown lengthening - hard tissue <br />D4260 Osseous surgery (including flap entry and closure) - four or more contiguous teeth or <br />bounded teeth spaces per quadrant <br />D4261 Osseous surgery (including flap entry and closure) - one to three contiguous teeth or <br />bounded teeth spaces per quadrant <br />D4263 Bone replacement graft - first site in quadrant <br />D4264 Bone replacement graft - each additional site in quadrant <br />D4265 Biologic materials to aid in soft and osseous tissue regeneration <br />D4266 Guided tissue regeneration - resorbable barrier, per site <br />D4267 Guided tissue regeneration - nonresorbable barrier, per site (includes membrane removal) <br />D4268 Surgical revision procedure, per tooth <br />D4270 Pedicle soft tissue graft procedure <br />D4271 Free soft tissue graft procedure (including donor site surgery) <br />D4273 Subepithelial connective tissue graft procedures, per tooth <br />D4274 Distal or proximal wedge procedure (when not performed in conjunction with surgical <br />procedures in the same anatomical area) <br />D4275 Soft tissue allograft <br />D4276 Combined connective tissue and double pedicle graft, per tooth
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