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D4266 Guided tissue regeneration - resorbable barrier, per site <br />D4267 Guided tissue regeneration - nonresorbable barrier, per site (includes membrane <br />removal) <br />D4268 Surgical revision procedure, per tooth <br />D4270 Pedicle soft tissue graft procedure <br />D4273 Autogenous connective tissue graft procedure (including donor and recipient surgical <br />sites) first tooth, implant, or edentulous tooth position In graft <br />D4274 Mesial/distal wedge procedure, single tooth (when not performed In conjunction with <br />surgical procedures in the same anatomical area) <br />D4275 Non -autogenous connective tissue graft (Including recipient site and donor material) <br />first tooth, Implant, or edentulous tooth position in graft <br />D4276 Combined connective tissue and double pedicle graft, per tooth <br />D4277 Free soft tissue graft procedure (Including recipient and donor surgical sites), first <br />tooth, Implant, or edentulous tooth position in graft <br />D4278 Free soft tissue graft procedure (including recipient and donor surgical sites), each <br />additional contiguous tooth, Implant, or edentulous tooth position In same graft site <br />D4283 Autogenous connective tissue graft procedure (including donor and recipient surgical <br />sites) - each additional contiguous tooth, implant or edentulous tooth position In same <br />graft site <br />D4285 Non -autogenous connective tissue graft procedure (including recipient surgical site <br />and donor material) - each additional contiguous tooth, implant or edentulous tooth <br />position In same graft site. <br />Non-surgical periodontal service <br />D4320 Provisional splinting - Intracoronal <br />D4321 Provisional splinting - extracoronal <br />D4341 Periodontal scaling and root planing - four or more teeth per quadrant <br />D4342 Periodontal scaling and root planing, - one to three teeth, per quadrant <br />D4346 Scaling In presence of generalized moderate or severe gingival inflammation <br />full mouth, after oral evaluation <br />D4355 Full mouth debridement to enable comprehensive evaluation and diagnosis on <br />subsequent visit <br />D4381 Localized delivery of antimicrobial agents via controlled release vehicle Into diseased <br />crevicular tissue, per tooth <br />Other periodontal services <br />D4910 Perlodontal maintenance <br />D4920 Unscheduled dressing change (by someone other than treating dentist or their staff) <br />D4999 Unspecified perlodontal procedure, by report <br />1135000 - D5899 PROSTHODONTICS (REMOVABLE) <br />Complete dentures (including routine post -delivery care) <br />D5110 Complete denture - maxillary <br />D5120 Complete denture - mandibular <br />D5130 Immediate denture - maxillary <br />D5140 Immediate denture - mandibular <br />Partial dentures (including routine post -delivery care) <br />D5211 Maxillary partial denture - resin base (Including any conventional clasps, rests and <br />teeth) <br />D5212 Mandibular partial denture - resin base (including any conventional clasps, rests and <br />teeth) <br />D5213 Maxillary partial denture - cast metal framework with resin denture bases (including <br />any conventional clasps, rests and teeth) <br />D5214 Mandibular partial denture - cast metal framework with resin denture bases (Including <br />any conventional clasps, rests and teeth) <br />D5221 Immediate maxillary partial denture - resin base (Including any conventional clasps, <br />rests and teeth) <br />CDT2018 (Eff. 01-01-18) <br />25C-81 <br />