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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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D7294 Placement of temporary anchorage device without flap; includes device removal <br />D7296 Corticotomy - one to three teeth or tooth spaces, per quadrant <br />D7297 Corticotomy - four or more teeth or tooth spaces, per quadrant <br />Alveoloplasty - surgical preparation of ridge for dentures <br />D7310 Alveoloplasty In conjunction with extractions - four or more teeth or tooth spaces, per <br />quadrant <br />D7311 Alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per <br />quadrant <br />D7320 Alveoloplasty not In conjunction with extractions - four or more teeth or tooth spaces, <br />per quadrant <br />D7321 Alveoloplasty not in conjunction with extractions - one to three teeth or tooth spaces, <br />perquadrant <br />Vestibuloplasty <br />D7340 Vestibuloplasty - ridge extension (secondary epithelialization) <br />D7350 Vestibuloplasty - ridge extension (Including soft tissue grafts, muscle reattachment, <br />revision of soft tissue attachment and management of hypertrophied and hyperplastic <br />tissue) <br />Surgical excision of soft tissue lesions <br />D7410 Excision of benign lesion up to 1.25 cm <br />D7411 Excision of benign lesion greater than 1.25 cm <br />D7412 Excision of benign lesion, complicated <br />D7413 Excision of malignant lesion up to 1.25 cm <br />D7414 Excision of malignant lesion greater than 1.25 cm <br />D7415 Excision of malignant lesion complicated <br />D7465 Destruction of lesion(s) by physical or chemical method, by report <br />Surgical excision of intra-osseous lesions <br />07440 Excision of malignant tumor - lesion diameter up to 1.25 cm <br />D7441 Excision of malignant tumor - lesion diameter greater than 1.25 cm <br />D7450 Removal of benign odontogenic cyst or tumor - lesion diameter up to 1.25 cm <br />D7451 Removal of benign odontogenic cyst or tumor - lesion diameter greater than 1.25 cm <br />D7460 Removal of benign nonodontogenic cyst or tumor - lesion diameter up to 1.25 cm <br />D7461 Removal of benign nonodontogenic cyst or tumor - lesion diameter greater than 1.25 <br />cm <br />Excision of bone tissue <br />D7471 Removal of lateral exostosis (maxilla or mandible) <br />D7472 Removal of torus palatinus <br />D7473 Removal of torus manibularis <br />D7485 Reduction of osseous tuberosity <br />07490 Radical resection of maxilla or mandible <br />Surgical incision <br />D7510 Incision and drainage of abscess - Intraoral soft tissue <br />D7511 Incision and drainage of abscess - intraoral soft tissue - complicated (Includes <br />drainage of multiple fasclal spaces) <br />D7520 Incision and drainage of abscess - extraoral soft tissue <br />D7521 Incision and drainage of abscess - extraoral soft tissue - ccrripllcated (includes <br />drainage of multiple fascial spaces) <br />D7530 Removal of foreign body from mucosa, skin or subcutaneous alveolar tissue <br />D7540 Removal of reaction -producing foreign bodies, musculoskeletal system <br />D7550 Partial ostectomy/sequestrectomy for removal of non-vltal bone <br />D7560 Maxillary sinusotomy for removal of tooth fragment or foreign body <br />12 CX200 (Eff. 01-01-1e) <br />25C-87 <br />
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