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AMERICAN DENTAL ASSOCIATION CDT-2017CODE ON DENTAL PROCEDURES AND NOMENCLATUREEffective January 1, 2017D0100-D0999 DIAGNOSTICCLINICAL ORAL 0Periodic oral evaluation - established patientLimited oral evaluation - problem focusedOral evaluation for a patient under three years of age and counseling with primary caregiverComprehensive oral evaluation - new or established patientDetailed and extensive oral evaluation - problem focused, by reportRe-evaluation - limited, problem focused (established patient; not post-operative visit)Re-evaluation - post-operative office visitComprehensive periodontal evaluation - new or established patientPRE-DIAGNOSTIC SERVICESD0190D0191Screening of a patientAssessment of a patientDIAGNOSTIC IMAGINGImage Capture with InterpretationD0210D0220D0230D0240D0250Intraoral - complete series of radiographic imagesIntraoral - periapical first radiographic imageIntraoral - periapical each additional radiographic imageIntraoral - occlusal radiographic imageExtraoral - 2D projection radiographic image created using a stationary radiation source, and 367Extraoral posterior dental radiographic imageBitewing - single radiographic imageBitewings - two radiographic imagesBitewings - three radiographic imagesBitewings - four radiographic imagesVertical bitewings - 7 to 8 radiographic imagesPosterior-anterior or lateral skull and facial bone survey radiographic imageSialographyTemporomandibular joint arthrogram, including injectionOther temporomandibular joint radiographic images, by reportTomographic surveyPanoramic radiographic image2D cephalometric radiographic image - acquisition, measurement and analysis2D oral/facial photographic image obtained intra-orally or extra-orally3D photographic imageCone beam CT capture and interpretation with limited field of view – less than one whole jawCone beam CT capture and interpretation with field of view of one full dental arch – mandibleCone beam CT capture and interpretation with field of view of one full dental arch – maxilla, with orwithout craniumCone beam CT capture and interpretation with field of view of both jaws; with or without craniumD0368D0369D0370D0371Cone beam CT capture and interpretation for TMJ series including two or more exposuresMaxillofacial MRI capture and interpretationMaxillofacial ultrasound capture and interpretationSialoendoscopy capture and interpretationCDT-2017Effective 01/01/2017*Procedure code is not in numeric order.New - yellowDeleted - redRevised nomenclature - blue1

AMERICAN DENTAL ASSOCIATION CDT-2017CODE ON DENTAL PROCEDURES AND NOMENCLATUREEffective January 1, 2017Image Capture OnlyD0380D0381D0382D0383D0384D0385D0386Cone beam CT image capture with limited field of view – less than one whole jawCone beam CT image capture with field of view of one full dental arch – mandibleCone beam CT image capture with field of view of one full dental arch – maxilla, with or withoutcraniumCone beam CT image capture with field of view of both jaws; with or without craniumCone beam CT image capture for TMJ series including two or more exposuresMaxillofacial MRI image captureMaxillofacial ultrasound image captureInterpretation and Report OnlyD0391Interpretation of diagnostic image by a practitioner not associated with capture of the image, includingreportPost Processing of Image or Image SetsD0393D0394D0395Treatment simulation using 3D image volumeDigital subtraction of two or more images or image volumes of the same modalityFusion of two or more 3D image volumes of one or more modalitiesTESTS AND y processing of microbial specimen to include culture and sensitivity studies, preparation andtransmission of written reportCollection of microorganisms for culture and sensitivityViral cultureCollection and preparation of saliva sample for laboratory diagnostic testingAnalysis of saliva sampleCollection and preparation of genetic sample material for laboratory analysis and reportGenetic test for susceptibility to disease - specimen analysisCaries susceptibility testsAdjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignantand malignant lesions, not to include cytology or biopsy proceduresPulp vitality testsDiagnostic castsNon-ionizing diagnostic procedure capable of quantifying, monitoring and recording changes instructure of enamel, dentin and cementumCaries risk assessment and documentation, with a finding of low riskCaries risk assessment and documentation, with a finding of moderate riskCaries risk assessment and documentation, with a finding of high riskORAL PATHOLOGY LABORATORYD0472D0473Accession of tissue, gross examination, preparation and transmission of written reportAccession of tissue, gross and microscopic examination, preparation and transmission of written reportD0474Accession of tissue, gross and microscopic examination, including assessment of surgical margins forpresence of disease, preparation and transmission of written reportD0480* Accession of exfoliative cytologic smears, microscopic examination, preparation and transmission ofwritten reportD0486* Laboratory accession of transepithelial cytologic sample, microscopic examination, preparation andtransmission of written reportCDT-2017Effective 01/01/2017*Procedure code is not in numeric order.New - yellowDeleted - redRevised nomenclature - blue2

AMERICAN DENTAL ASSOCIATION CDT-2017CODE ON DENTAL PROCEDURES AND NOMENCLATUREEffective January 1, 0485D0502Decalcification procedureSpecial stains for microorganismsSpecial stains, not for microorganismsImmunohistochemical stainsTissue in-situ hybridization, including interpretationElectron microscopyDirect immunofluorescenceIndirect immunofluorescenceConsultation on slides prepared elsewhereConsultation, including preparation of slides from biopsy material supplied by referring sourceOther oral pathology procedures, by reportD0999Unspecified diagnostic procedure, by reportD1000-D1999 PREVENTIVEDENTAL PROPHYLAXISD1110D1120Prophylaxis - adultProphylaxis - childTOPICAL FLUORIDE TREATMENT (OFFICE PROCEDURE)D1206D1208Topical application of fluoride varnishTopical application of fluoride - excluding varnishOTHER PREVENTIVE ional counseling for control of dental diseaseTobacco counseling for the control and prevention of oral diseaseOral hygiene instructionsSealant - per toothSealant repair - per toothPreventive resin restoration in a moderate to high caries risk patient – permanent toothInterim caries arresting medicament applicationSPACE MAINTENANCE (PASSIVE e maintainer - fixed - unilateralSpace maintainer - fixed - bilateralSpace maintainer - removable - unilateralSpace maintainer - removable - bilateralRe-cement or re-bond space maintainerRemoval of fixed space maintainerDistal shoe space maintainer - fixed - unilateralD1999Unspecified preventive procedure, by reportD2000-D2999 RESTORATIVEAMALGAM RESTORATIONS (INCLUDING POLISHING)D2140D2150Amalgam - one surface, primary or permanentAmalgam - two surfaces, primary or permanentCDT-2017Effective 01/01/2017*Procedure code is not in numeric order.New - yellowDeleted - redRevised nomenclature - blue3

AMERICAN DENTAL ASSOCIATION CDT-2017CODE ON DENTAL PROCEDURES AND NOMENCLATUREEffective January 1, 2017D2160D2161Amalgam - three surfaces, primary or permanentAmalgam - four or more surfaces, primary or permanentRESIN-BASED COMPOSITE RESTORATIONS - sitecompositecompositecomposite- one surface, anterior- two surfaces, anterior- three surfaces, anterior- four or more surfaces or involving incisal angle (anterior)crown, anterior- one surface, posterior- two surfaces, posterior- three surfaces, posterior- four or more surfaces, posteriorGOLD FOIL RESTORATIONSD2410D2420D2430Gold foil - one surfaceGold foil - two surfacesGold foil - three surfacesINLAY/ONLAY 20D2630D2642D2643D2644Inlay - metallic - one surfaceInlay - metallic - two surfacesInlay - metallic - three or more surfacesOnlay - metallic - two surfacesOnlay - metallic - three surfacesOnlay - metallic - four or more surfacesInlay - porcelain/ceramic - one surfaceInlay - porcelain/ceramic - two surfacesInlay - porcelain/ceramic - three or more surfacesOnlay - porcelain/ceramic - two surfacesOnlay - porcelain/ceramic - three surfacesOnlay - porcelain/ceramic - four or more surfaces**Porcelain/ceramic inlays/onlays include all indirect ceramic and porcelain type inlays/onlays.D2650D2651D2652D2662D2663D2664Inlay - resin-based composite - one surfaceInlay - resin-based composite - two surfacesInlay - resin-based composite - three or more surfacesOnlay - resin-based composite - two surfacesOnlay - resin-based composite - three surfacesOnlay - resin-based composite - four or more surfaces**Resin-based composite inlays/onlays must utilize indirect technique.CROWNS - SINGLE RESTORATIONS rownCrownCrownCrownCrown-resin-based composite (indirect)¾ resin-based composite (indirect)resin with high noble metalresin with predominantly base metalresin with noble metalporcelain/ceramic substrateporcelain fused to high noble metalCDT-2017Effective 01/01/2017*Procedure code is not in numeric order.New - yellowDeleted - redRevised nomenclature - blue4

AMERICAN DENTAL ASSOCIATION CDT-2017CODE ON DENTAL PROCEDURES AND NOMENCLATUREEffective January 1, 2794D2799Crown - porcelain fused to predominantly base metalCrown - porcelain fused to noble metalCrown - 3/4 cast high noble metalCrown - 3/4 cast predominantly base metalCrown - 3/4 cast noble metalCrown - 3/4 porcelain/ceramicCrown - full cast high noble metalCrown - full cast predominantly base metalCrown - full cast noble metalCrown - titaniumProvisional crown– further treatment or completion of diagnosis necessary prior to final impressionOTHER RESTORATIVE D2982D2983Resin infiltration of incipient smooth surface lesionsRe-cement or re-bond inlay, onlay, veneer or partial coverage restorationRe-cement or re-bond indirectly fabricated or prefabricated post and coreRe-cement or re-bond crownReattachment of tooth fragment, incisal edge or cuspPrefabricated porcelain/ceramic crown – primary toothPrefabricated stainless steel crown - primary toothPrefabricated stainless steel crown - permanent toothPrefabricated resin crownPrefabricated stainless steel crown with resin windowPrefabricated esthetic coated stainless steel crown - primary toothProtective restorationInterim therapeutic restoration – primary dentitionRestorative foundation for an indirect restorationCore buildup, including any pins when requiredPin retention - per tooth, in addition to restorationPost and core in addition to crown, indirectly fabricatedEach additional indirectly fabricated post - same toothPrefabricated post and core in addition to crownEach additional prefabricated post - same toothPost removalLabial veneer (resin laminate) - chairsideLabial veneer (resin laminate) - laboratoryLabial veneer (porcelain laminate) - laboratoryAdditional procedures to construct new crown under existing partial denture frameworkCopingCrown repair necessitated by restorative material failureInlay repair necessitated by restorative material failureOnlay repair necessitated by restorative material failureVeneer repair necessitated by restorative material failureD2999Unspecified restorative procedure, by reportD3000-D3999 ENDODONTICSPULP CAPPINGD3110Pulp cap - direct (excluding final restoration)CDT-2017Effective 01/01/2017*Procedure code is not in numeric order.New - yellowDeleted - redRevised nomenclature - blue5