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DELTA DENTAL
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Last modified
3/27/2018 10:28:51 AM
Creation date
3/27/2018 10:16:23 AM
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Contracts
Company Name
DELTA DENTAL
Contract #
A-2018-021
Agency
PERSONNEL SERVICES
Council Approval Date
2/6/2018
Expiration Date
12/31/2019
Destruction Year
2024
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D2790 Crown - full cast high noble metal <br />D2791 Crown - full cast predominantly base metal <br />D2792 Crown - full cast noble metal <br />D2794 Crown - titanium <br />D2799 Provisional crown - further treatment or completion of a diagnosis necessary prior to <br />final Impression <br />Other restorative services <br />D2910 Re -cement or re -bond Inlay, onlay, veneer or partial coverage restorations <br />D2915 Re -cement or re -bond Indirectly fabricated or prefabricated post and core <br />D2920 Re -cement or re -band crown <br />D2921 Reattachment of tooth fragment, Incisal edge or cusp <br />D2929 Prefabricated porcelain/ceramic crown - primary tooth <br />02930 Prefabricated stainless steel crown - primary tooth <br />D2931 Prefabricated stainless steel crown - permanent tooth <br />D2932 Prefabricated resin crown <br />D2933 Prefabricated stainless steel crown with resin window <br />D2934 Prefabricated esthetic coated stainless steel crown - primary tooth <br />D2940 Sedative fllling <br />D2941. Interim therapeutic restoration - primary dentition <br />D2950 Core buildup, Including any pins when required <br />D2951 Pin retention - per tooth, In addition to restoration <br />D2952 Post and core In addition to crown, Indirectly fabricated <br />D2953 Each additional Indirectly fabricated post - same tooth <br />D2954 Prefabricated post and core In addition to crown <br />D2955 Post removal <br />D2957 Each additional prefabricated post - same tooth <br />D2960 Labial veneer (resin laminate) - chalrslde <br />D2961 Labial veneer (resin laminate) - laboratory <br />D2962 Labial veneer (porcelain laminate) - laboratory <br />D2971 Additional procedures to construct new crown under existing partial denture <br />framework <br />D2975 Coping <br />D2980 Crown repair, necessitated by restorative material failure <br />D2999 Unspecified restorative procedure, by report <br />D300O - D3999 ENDODONTICS <br />Pulp capping <br />D3110 Pulp cap - direct (excluding final restoration) <br />D3120 Pulp cap - indirect (excluding final restoration) <br />Pulpotomy <br />D3220 Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the <br />dentinocemental junction and application of medicament <br />D3221 Pulpal debridement, primary and permanent teeth <br />D3222 Partial pulpotomy for apexogenesls-permanent tooth with incomplete root <br />development <br />D3230 Pulpal therapy (resorbable filling) - anterior, primary tooth (excluding final <br />restoration) <br />D3240 Pulpal.therapy (resorbable filling) = posterior, primary tooth (excluding final <br />restoration) <br />Endodontic therapy on primary teeth (including treatment plan, clinical procedures and.. <br />follow-up care) <br />D3310 Endodontic therapy, anterior tooth (excluding final restoration) <br />D3320 Endodontic therapy, premolar tooth (excluding final restoration) <br />D3330 Endodontic therapy, molar tooth (excluding final restoration) <br />CDT2018 (Eff. 01-01-19) <br />25C-79 <br />
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