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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 />D010O - D0999 DIAGNOSTIC <br />Clinical oral evaluations <br />D0120 Periodic oral evaluation - established patient <br />D0140 Limited oral evaluation — problem focused <br />DO145 Oral evaluation for a patient under three years of age and counseling with primary <br />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 <br />visit) <br />D0180 Comprehensive periodontal evaluation — new or established patient <br />D0190 Screening of a patient <br />D0191 Assessment of a patient <br />Radiographs /diagnostic imaging (including interpretation) <br />D0210 Intraoral — complete series of radiographic images <br />D0220 Intraoral — periapical first radiographic image <br />D0230 Intraoral — periapical each additional radiographic image <br />D0240 Intraoral — occlusal radiographic image <br />D0250 Extraoral — first radiographic image <br />D0260 Extraoral — each additional radiographic image <br />D0270 Bitewing — single radiographic image <br />D0272 Bitewings — two radiographic images <br />DO273 Bitewings - three radiographic images <br />D0274 Bitewings — four radiographic images <br />D0277 Vertical bitewings — 7 to 8 radiographic images <br />D0290 Posterior — anterior or lateral skull and facial bone survey radiographic image <br />D0310 Sialography <br />D0320 Temporomandibular joint arthrogram, including injection <br />D0321 Other temporomandibular joint radiographic images, by report <br />D0322 Tomographic survey <br />D0330 Panoramic radiographic image <br />D0340 Cephalometric radiographic image <br />D0350 Oral /facial photographic images obtained intraorally or extraorally <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 <br />Oral pathology laboratory <br />D0472 Accession of tissue, gross examination, preparation and transmission of written report <br />D0473 Accession of tissue, gross and microscopic examination, preparation and transmission <br />of written report <br />CDT2015 (Eff. 01- 01 -15) <br />