COMMON DENTAL PROCEDURE CODES USED IN DIRECT CARE PROGRAMS The Dental Data Reporting System of the IHS accepts all DO272 Bitewings, Two Films D2931 Crown-Stainless Steel, Perm. Tooth procedure codes listed in the Current Dental Terminology DO273 Bitewings, Three Films D2932 Crown-Prefab. Resin, Primary Tooth (CDT) published by the American Dental Association as DO274 Bitewings, Four Films D2940 Sedative Filling well as unique codes (in boldface) created by the IHS. DO330 Panoramic-Maxilla And Mandible Film D2950 Core Buildup, Including Any Pins

Use of exam codes: The 01 14 Screening Exam is used DO340 Cephalometric Film D2951 Pin Retention (Per Tooth) Excludes Restoration

when no dental chart is made (e.g., large groups of school DO350 OrallFacial Images D2954 Post And Core (Prefab.), Excl Crown children). The DO140 Problem-focused Examination is DO425 Caries Susceptibility Test D2970 Temporary Crown (fractured tooth) limited to diagnosing a specific, urgent problem (dental DO460 Pulp Vitality Tests (Per Quad) emergency). It can be reported each time an individual DO470 Diagnostic Casts (Per Set) ENDODONTICS

presents with a problem, but not with other exam codes at DO471 Diagnostic Photographs D3110 Pulp Cap, Direct (Excluding Final Restoration)

the same appointment. The DO150 Comprehensive Exam D3220 Vital Pulpotomy, Primary or Perm. Tooth

includes the completion of a new oral health record, rather PREVENTIVE SERVICES D3221 Pulpal Debridement, Primary or Perm Tooth

than updating an existing chart, which is when the DO120 D l 110 Prophylaxis, Adult (Permanent Dentition) D3222 Partial Pulpotomy for Apexogenesis, Perm Tooth Periodic Exam should be reported. The DO160 Extensive D l 120 Prophylaxis, Child (Primary or Mixed Dentition) D3230 Pulp Therapy, Primary Anterior Problem-focused Exam may be used after a DO120 or Dl203 Topical Fluoride Not Including Prophy-Child D3240 Pulp Therapy, Primary Posterior DO1 50 has been recently reported, when patients require a Dl204 Topical Fluoride Not Including Prophy-Adult D3310 Endodontic Fill, Anterior detailed treatment plan for a specific problem (e.g., a case Dl206 Topical Fluoride Varnish (mod to high risk pts) D3320 Endodontic Fill, Bicuspid work-up for periodontics, prosthodontics, orthodontics or D l 310 Nutritional Counseling For Oral Health D3330 Endodontic Fill, Molar oral surgery). The DO160 evaluation may be documented D l 320 Tobacco Use Counseling D3346 Retreat Previous Endo Fill - Anterior on special forms in lieu of the oral health record used D l 330 Oral Hygiene Instructions 03347 Retreat Previous Endo Fill -Bicuspid routinely for the DO120 and DO150 codes. The DO180 is D l 351 Sealant (per tooth) D3348 Retreat Previous Endo Fill -Molar used for comprehensive periodontal examinations of patients with signs or symptoms of periodontal disease or D l 510 Space Maintainer, Fixed Unilateral D3351 ApexificationlRecalcify, Initial Visit

risk factors (e.g. diabetes, smoking). D l 51 5 Space Maintainer, Fixed Bilateral D3352 ApexificationlRecalcify, Interim Visit Dl550 Space Maintainer, Recementation D3353 ApexificationlRecalcify, Final Visit

PERSONS SERVED (ENCOUNTER CODES) D l 555 Removal of Fixed Space Maintainer D3410 Apicoectomy/Periradicular Surg., Ant. Tooth 0000 First Visit (of fiscal year by the patient) D3430 Retrograde Filling, Per Root 0190 Dental Revisit (For Any Reason) . RESTORATIVE DENTISTRY D3950 Fitting For Preformed Dowel 0003 BBTDIECC Dental Patient D2140 Amalgam, One Surface (Perm or Primary) D3960 Bleach Discolored Tooth (Vital or Non-Vital) 0004 Head Start Program Dental Patient 02150 Amalgam, Two Surface (Perm or Primary)

0007 High-risk Periodontal Patient D2160 Amalgam, Three Surface (Perm or Primary) D2161 Amalgam, Four+ Surfaces (Perm or Primary)

PERIODONTICS 9320 Diabetic Screening Procedures D4210 Gingivectomy Or Gingivoplasty (4 or more contig. teeth) 9321 Diabetic Referral Or Follow-up D2330 Composite Resin, One Surface, Anterior D4211 Gingivectomy Or Gingivoplasty (1 to 3 teeth) 9330 Hypertension Screening D2331 Composite Resin, Two Surfaces, Anterior D4240 Gingival Flap Proc. wl Root Planing (4 or more contig. teeth) 9331 Hypertension Referral Or Follow-up D2332 Composite Resin, Three Surfaces, Anterior 04241 Gingival Flap Proc. wl Root Planing (1 to 3 teeth) 9340 Dental Visit, Pre-Natal Mother D2335 Composite Resin, Four Surfaces or lncisal D4249 Crown Lengthening Proc. - Hard Tissue 9341 Dental Visit, Nursing Mother D2390 Composite Resin Crown, Anterior D4260 Osseous Surgery (4 or more contig. teeth) 9990 Planned Treatment Completed D2391 Comp Resin, One Surf., Post., Perm or Prim (includes PRR) 04261 Osseous Surgery to teeth) 9991 Patient Refuses Recommended Treatment D2392 Composite Resin, Two Surfaces, Post. (Perm or Primary) ~ 4 2 6 3 Bone Replacement Graft, First Site In Quadrant

D2393 Composite Resin, Three Surfaces, Post. (Perm or Primary) D4274 Distal Prox, Wedge Procedure ( ~ 1 ~ other surg) DIAGNOSTIC SERVICES D2394 Composite Resin, Four Surfaces, Post. (Perm or Primary) D4341 Root Planing (4 or more contig, teeth) DO1 20 Periodic Oral Evaluation (update existing chart) D2740 Crown-PorcelainlCeramic Substrate D4342 Root Planing (1 to 3 teeth) DO140 Limited Evaluation-Problem Focused (Emerg. Exam: D2750 Crown-Porcelain Fused To High Noble Metal 04355 Full Mouth Debridement (For Perio. Evaluation) DO145 Oral Evaluation for Patient under 3 years of age D2751 Crown-Porcelain Fused to Base Metal D4381 Controlled Release Of Chemo. Agents, Per Site DO150 Comprehensive Oral Evaluation (new chart made) D2752 Crown-Porcelain Fused To Noble Metal D4910 Periodontal Maintenance After Therapy DO160 Extensive Oral Evaluation-Problem Focused D2790 Crown- Full Cast High Noble Metal DO180 Comprehensive Periodontal Evaluation D2791 Crown-Full Cast Base Metal DO210 lntraoral Complete Series D2792 Crown-Full Cast Noble Metal DO220 lntraoral Periapical, Single Film D2799 Provisional Crown DO230 lntraoral Periapical, Additional Film D2915 Recement CastIPrefab Post and Core DO240 lntraoral Film D2920 Recement Crowns DO270 Bitewings, Single Film ' D2930 Crown-Stainless Steel, Primary Tooth

Revised Jan 2009