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Professional visits <br />D9410 House /extended care facility call <br />D9420 Hospital call <br />D9430 Office visit for observation (during regularly scheduled hours) — no other services <br />performed <br />D9440 Office visit — after regularly scheduled hours <br />D9450 Case presentation, detailed and extensive treatment planning <br />Drugs <br />D9610 Therapeutic parenteral drug, single administration <br />D9612 Therapeutic parenteral drugs, two or more administrations, different medications <br />D9630 Other drugs and /or medicaments, by report <br />Miscellaneous services <br />D9910 Application of desensitizing medicament <br />D9911 Application of desensitizing resin for cervical and /or root surface, per tooth <br />D9920 Behavior management, by report <br />D9930 Treatment of complications (post - surgical) — unusual circumstances, by report <br />D9940 Occlusal guard, by report <br />D9941 Fabrication of athletic mouthguard <br />D9942 Repair and /or reline of occlusal guard <br />D9950 Occlusion analysis — mounted case <br />D9951 Occlusal adjustment — limited <br />D9952 Occlusal adjustment — complete <br />D9970 Enamel microabrasion <br />D9971 Odontoplasty 1 -2 teeth; includes removal of enamel projections <br />D9972 External bleaching — per arch - performed in office <br />D9973 External bleaching — pertooth <br />D9974 Internal bleaching — pertooth <br />D9999 Unspecified adjunctive procedure, by report <br />Note: This Appendix represents codes and nomenclature excerpted from the version of Current <br />Dental Terminology (CDT) in effect at the date of this printing. CDT coding and nomenclature are the <br />copyright of the American Dental Association, and have been accepted as the standard for data <br />transmission purposes under federal Administrative Simplification regulations. For the purposes of <br />this Appendix, Delta Dental's administration of Benefits, Limitations and Exclusions under this <br />Contract will at all times be based on the then - current version of CDT whether or not a revised <br />Appendix B is provided. <br />CDT2015 (Eff. 01- 01 -15) <br />