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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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Treatment of fractures - simple <br />D7610 Maxilla - open reduction (teeth Immobilized, If present) <br />D7620 Maxilla - closed reduction (teeth Immobilized, If present) <br />D7630 Mandible - open reduction (teeth Immobilized, If present) <br />D7640 Mandible - closed reduction (teeth Immobilized, if present) <br />D7650 Malar and/or zygomatic arch - open reduction <br />D7660 Malar and/or zygomatic arch - closed reduction <br />D7670 Alveolus - closed reduction, may include stabilization of teeth <br />D7671 Alveolus - open reduction, may include stabilization of teeth <br />D7680 Facial bones - complicated reduction with fixation and multiple surgical approaches <br />Treatment of fractures - compound <br />D7710 Maxilla - open reduction <br />D7720 Maxilla - closed reduction <br />D7730 Mandible - open reduction <br />D7740 Mandible - closed reduction <br />D7750 Malar and/or zygomatic arch - open reduction <br />07760 Malar and/or zygomatic arch -closed reduction <br />D7770 Alveolus - open reduction splinting stabilization of teeth <br />07771 Alveolus - closed reduction stabilization of teeth <br />D7780 Facial bones - complicated reduction with fixation and multiple approaches <br />Reduction of dislocation and management of other temporomandibular joint dysfunctions <br />D7810 Open reduction of dislocation <br />D7820 Closed reduction of dislocation <br />D7830 Manipulation under anesthesia <br />D7840 Condylectomy <br />D7850 Surgical discectomy, with/without Implant <br />D7852 Disc repair <br />D7854 Synovectomy <br />D7856 Myotomy <br />D7858 Joint reconstruction <br />D7860 Arthrotomy <br />D7865 Arthroplasty <br />D7870 Arthrocentesis <br />D7871 Non -arthroscopic lysis and lavage <br />D7872 Arthroscopy - diagnosis, with or without biopsy <br />D7873 Arthroscopy: lavage and lysis of adhesions <br />D7874 Arthroscopy: disc repositioning and stabilization <br />D7875 Arthroscopy: synovectomy <br />D7876 Arthroscopy: discectomy <br />D7877 Arthroscopy: debridement <br />D7880 Occlusal orthotic device, by report <br />D7881 Occlusal orthotic device adjustment <br />D7899 Unspecified TMD therapy, by report <br />Repair of traumatic wounds <br />D7910- Suture of recent small wounds up to 5 cm <br />Complicated suturing (reconstruction requiring delicate handling of tissues and wide <br />undermining for meticulous closure) <br />D7911 Complicated suture - up to 5 cm <br />D7912 Complicated suture - greater than 5 cm <br />Other repair procedures <br />D7920 Skin graft (Identify defect covered, location and type of graft) <br />D7940 Osteoplasty - for orthognathic deformities <br />D7941 Osteotomy - mandibular rams <br />13 CDT2018 (Eff, 01-01-18) <br />25C-88 <br />
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