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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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D3331 Treatment of root canal obstruction; non-surgical access <br />D3332 Incomplete endodontic therapy; inoperable, unrestorable or fractured tooth <br />D3333 Internal root repair of perforation defects <br />Endodontic retreatment <br />D3346 Retreatment of previous root canal therapy - anterior <br />D3347 Retreatment of previous root canal therapy - premolar <br />D3348 Retreatment of previous roof canal therapy - molar <br />Apexification/recalcification procedures <br />D3351 Apexiflcatlon/recalcification - Initial visit (aplcai closure/calcific repair of perforations, <br />root resorption, etc,) <br />D3352 Apexification/recalcification - Interim medication replacement (apical closure/calcific <br />repair of perforations, root resorption, pulpal space disinfection, etc,) <br />D3353 Apex! fication/recaIclMcation - final visit (Includes completed root canal therapy - <br />apical closure/calcific repair of perforations, root resorption, etc,) <br />Apicoectomy/periradicular services <br />D3410 Apicoectomy - anterior <br />D3421 Apicoectomy - premolar (first root) <br />D3425 Apicoectomy - molar (first root) <br />D3426 Apicoectomy (each additional root) <br />D3427 Perladicular surgery without apicoectomy <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 <br />spaces per quadrant <br />D4211 Gingivectomy or gingivoplasty - one to three contiguous teeth or bounded teeth <br />spaces per quadrant <br />D4212 Gingivectomy or gingivoplasty - to allow access for restorative procedure, per tooth <br />D4230 Anatomical crown exposure - four or more contiguous teeth or bounded tooth spaces <br />per quadrant <br />D4231 Anatomical crown exposure - one to three teeth or bounded tooth spaces per quadrant <br />D4240 Gingival flap procedure, Including root planing - four or more contiguous teeth or <br />bounded teeth spaces per quadrant <br />D4241 Gingival flap procedure, Including root planing - one to three contiguous teeth or <br />bounded teeth spaces per quadrant <br />D4245 Apically positioned flap <br />D4249 Clinical crown lengthening - hard tissue <br />D4260 Osseous surgery (Including elevation of a full thickness flap and closure) - four or <br />more contiguous teeth or tooth bounded spaces per quadrant <br />D4261 Osseous surgery (including elevation of a full thickness flap and closure) - one to three <br />contiguous teeth or tooth bounded spaces per quadrant <br />D4263 Bone replacement graft - retained natural tooth - flrst site In quadrant <br />D4264 Bone replacement graft - retained natural tooth - each additional site in quadrant <br />D4265 Biologic materials to aid in soft and osseous tissue regeneration <br />CDT2018 (Eff, 01-01-18) <br />
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