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THREE RADIOGRAPHIC IMAGES F 00022.09 07012025 99999999 D D0274 BITEWINGS-FOUR RADIOGRAPHIC IMAGES F 00027.30 07012025 99999999 D D0321 TEMPORAMANDIBULAR JOINT RADIOGRAPHIC IMA F 00029.56 07012025 99999999 D D0330 PANORAMIC RADIOGRAPHIC IMAGE F 00051.16 07012025 99999999 D D0340 CEPHALOMETRIC IMAGE F 00051.16 07012025 99999999 D D0364 Cone beam ct capture&interpretation w/li F 00210.06 07012025 99999999 D D0365 Cone beam ct capture&interpret w/ field F 00210.06 07012025 99999999 D D0366 Cone beam ct capture&interpret w/field o F 00210.06 07012025 99999999 D D0367 Cone beam ct capture & interpret w/field F 00210.06 07012025 99999999 D D0368 Cone beam ct capture & interpret for tmj F 00210.06 07012025 99999999 D D0380 Cone beam ct image capture with limited F 00210.06 07012025 99999999 D D0381 Cone beam ct image capture with field of F 00210.06 07012025 99999999 D D0382 Cone beam ct image capture w/field of vi F 00210.06 07012025 99999999 D D0383 Cone beam ct image capture with field of F 00210.06 07012025 99999999 D D0384 Cone beam ct image capture for tmj serie F 00210.06 07012025 99999999 D D0391 Interpretation of diag image by a practi F 00224.27 07012025 99999999 D D0393 TRTMNT SIMULATION 3D IMAGE F 00310.70 07012025 99999999 D D0394 Digital subtraction of two or more image F 00079.87 07012025 99999999 D D0395 Fusion of two or more 3d image volumes o F 00079.87 07012025 99999999 D D0460 PULP VITALITY TESTS F 00020.20 07012025 99999999 D D0470 DIAGNOSTIC CASTS F 00039.80 07012025 99999999 D D0601 Caries risk assessment and documentation M 00000.00 01012014 99999999 D D0602 Caries risk assessment and documentation M 00000.00 01012014 99999999 D D0603 Caries risk assessment and documentation M 00000.00 01012014 99999999 D D1110 ADULT PROPHYLAXIS F 00042.27 07012025 99999999 D D1120 CHILD PROPHYLAXIS F 00028.99 07012025 99999999 D D1206 FLUORIDE VARNISH F 00016.91 07012025 99999999 D D1208 Topical application of fluoride F 00016.91 07012025 99999999 D D1351 SEALANT, PER TOOTH F 00024.15 07012025 99999999 D D1353 SEALANT REPAIR - 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ONE SURFACE ANTERIOR F 00057.86 07012025 99999999 D D2331 RESIN - TWO SURFACES ANTERIOR F 00073.75 07012025 99999999 D D2332 RESIN - THREE SURFACES, ANTERIOR F 00085.10 07012025 99999999 D D2335 RESIN 4/> SURF OR W INCIS AN F 00096.45 07012025 99999999 D D2390 RESIN BASED COMPOSITE CROWN ANTERIOR F 00096.45 07012025 99999999 D D2391 RESIN BASED COMPOSITE-ONE SURFACE POST. F 00057.86 07012025 99999999 D D2392 RESIN BASED COMPOSITE,TWO SURFACES POST. F 00080.35 07012025 99999999 D D2393 RESIN BASED COMPOSITE-3 SURFACE POSTER. F 00085.10 07012025 99999999 D D2394 RESIN BASED COMPOSITE-4 OR MORE SURFACES F 00096.45 07012025 99999999 D D2710 CROWN - RESIN-BASED COMPOSITE (INDIRECT) F 00170.22 07012025 99999999 D D2712 CROWN - 3/4 RESIN-BASED COMPOSITE (INDI F 00170.22 07012025 99999999 D D2720 CROWN, RESIN WITH HIGH NOBLE METAL F 00292.04 07012025 99999999 D D2721 CROWN, RESIN WITH PREDOMINANTLY BASE MET F 00561.70 07012025 99999999 D D2740 CROWN, PORCELAIN/CERAMIC SUBSTRATE F 00469.79 07012025 99999999 D D2750 CROWN, PORCELAIN FUSED TO HIGH NOBLE MET F 00522.00 07012025 99999999 D D2751 CROWN, PORCELAIN FUSED TO PREDOMINANTLY F 00465.25 07012025 99999999 D D2752 CROWN,PORCELAIN FUSED TO NOBLE METAL F 00527.67 07012025 99999999 D D2781 CROWN, 3/4 CAST PREDOMINATELY BASE METAL F 00443.91 07012025 99999999 D D2790 CROWN, FULL CAST HIGH NOBLE METAL F 00465.25 07012025 99999999 D D2791 CROWN, FULL CAST PREDOMINANTLY BASE META F 00448.23 07012025 99999999 D D2792 CROWN,FULL CAST NOBLE METAL F 00480.00 07012025 99999999 D D2910 RECEMENT INLAY, ONLAY, OR PARTIAL COVERA F 00043.12 07012025 99999999 D D2915 RECEMENT CAST OR PREFAB. POST AND CORE F 00034.04 07012025 99999999 D D2920 RECEMENT CROWN F 00034.04 07012025 99999999 D D2921 Reattachment of tooth fragment, incisal F 00117.91 07012025 99999999 D D2928 PREFABRICATED PORCELAIN/CERAMIC CROWN - F 00153.71 07012025 99999999 D D2929 PREFABRICATED PORCELAIN/CERAMIC CROWN - F 00139.74 07012025 99999999 D D2930 PREFABRICATED STAINLESS STEEL CROWN, PRI F 00113.48 07012025 99999999 D D2931 PREFABRICATED STAINLESS STEEL CROWN, PER F 00124.82 07012025 99999999 D D2932 PREFABRICATED RESIN CROWN F 00130.49 07012025 99999999 D D2933 PREFAB SSC WITH RESIN WINDOW F 00139.74 07012025 99999999 D D2934 PREFAB ESTHETIC COATED SS CROWN PRIMARY F 00139.74 07012025 99999999 D D2940 PROTECTIVE RESTORATION F 00035.17 07012025 99999999 D D2950 CORE BUILDUP, INCLUDING ANY PINS F 00122.82 07012025 99999999 D D2951 PIN RETENTION, PER TOOTH,IN ADDITION TO F 00013.61 07012025 99999999 D D2952 CAST POST AND CORE IN ADDITION TO CROWN F 00141.85 07012025 99999999 D D2954 PREFABRICATED POST AND CORE IN ADDITION F 00083.96 07012025 99999999 D D2971 ADD PROC CONSTRUCT NEW CROWN F 00055.52 07012025 99999999 D D2976 BAND STABILIZATION PER TOOTH F 00031.21 07012025 99999999 D D2980 CROWN REPAIR M 00000.00 06112012 99999999 D D2990 RESIN INFILTRATION OF INCIPIENT SMOOTH S M 00000.00 01012013 99999999 D D2999 UNSPECIFIED RESTORATIVE PROCEDURE M 00000.00 01012019 99999999 D D3220 THERAPEUTIC PULPOTOMY, EXCLUDING FINAL R F 00062.60 07012025 99999999 D D3221 PULPAL DEBRIDEMENT F 00077.89 07012025 99999999 D D3222 PARTIAL PULPOTOMY FOR APEXOGENESIS, PERM F 00140.59 07012025 99999999 D D3310 ENDODONTIC THERAPY-ANTERIOR(EXCLUDES FIN F 00269.81 07012025 99999999 D D3320 ENDODONTIC THERAPY-BISCUSPID(EXCLUDES FI F 00323.78 07012025 99999999 D D3330 ENDODONTIC THERAPY-MOLAR(EXCLUDES FINAL F 00415.53 07012025 99999999 D D3332 INCOMPLETE ENDODONTIC THERAPY; INOPERABL M 00000.00 08012012 99999999 D D3346 RETREATMENT OF PREV ROOT CANEL THERAPY F 00296.79 07012025 99999999 D D3347 RETREATMENT OF PREV ROOT CANAL THERAPY F 00356.17 07012025 99999999 D D3348 RETREATMENT OF PREV ROOT CANAL THERAPY F 00534.24 07012025 99999999 D D3351 APEXIFICAT/RECALC/PULPL REGEN-INITIAL F 00080.94 07012025 99999999 D D3352 APEXIFICAT/RECALC/PULPL REGEN-INTERIM F 00053.96 07012025 99999999 D D3353 APEXIFICATION/RECALCIF. FINAL VISIT INC F 00148.46 07012025 99999999 D D3355 Pulpal regeneration - initial visit F 00166.15 07012025 99999999 D D3356 Pulpal regeneration - interim medication F 00116.30 07012025 99999999 D D3357 Pulpal regeneration - completion of trea F 00116.30 07012025 99999999 D D3410 APICOECTOMY/PERIADICULAR SURG-ANTERIOR F 00249.32 07012025 99999999 D D3421 APICOECTOMY/PERIADICULAR SURGERY, BICUSP F 00333.50 07012025 99999999 D D3425 APICOECTOMY/PERIRADICULAR SURGERY, MOLAR F 00151.09 07012025 99999999 D D3426 APICOECTOMY/PERIRADICULAR SURGERY, EACH F 00053.98 07012025 99999999 D D3430 RETROGRADE FILLING, PER ROOT INCLUDING A F 00201.92 07012025 99999999 D D3450 ROOT AMPUTATION, PER ROOT F 00068.17 07012025 99999999 D D3471 SURGICAL REPAIR OF ROOT RESORPTION - ANT F 00126.68 07012025 99999999 D D3472 SURGICAL REPAIR OF ROOT RESORPTION - PRE F 00126.68 07012025 99999999 D D3473 SURGICAL REPAIR OF ROOT RESORPTION - MOL F 00126.68 07012025 99999999 D D3501 SURGICAL EXPOSURE OF ROOT SURFACE WITHOU F 00126.68 07012025 99999999 D D3502 SURGICAL EXPOSURE OF ROOT SURFACE WITHOU F 00126.68 07012025 99999999 D D3503 SURGICAL EXPOSURE OF ROOT SURFACE WITHOU F 00126.68 07012025 99999999 D D3921 DECORONATION OR SUBMERGENCE OF AN ERUPTE F 00053.96 07012025 99999999 D D3999 UNSPECIFIED ENDODONTIC PROCEDURE M 00000.00 06112012 99999999 D D4210 GINGIVECTOMY OR GINGIVOPLASTY-PER QUADRA F 00230.29 07012013 99999999 D D4211 GINGIVECTOMY OR GINGIVOPLASTY, 1-3 CONTI F 00115.14 07012013 99999999 D D4212 Gingivectomy or gingivoplasty to allow a F 00020.47 07012013 99999999 D D4240 GINGIVAL FLAP PROCEDURE, INCL ROOT PLANI M 00000.00 06112012 99999999 D D4241 GINGIVAL FLAP PROCED.INCLUD.ROOT PLANING M 00000.00 06112012 99999999 D D4245 APICALLY POSITIONED FLAP F 00313.10 04012014 99999999 D D4249 CROWN LENGTHENING M 00000.00 01012019 99999999 D D4260 OSSEOUS SURGERY, INC FLAP ENTRY AND CLOS F 00419.64 07012013 99999999 D D4261 OSSEOUS SURGERY 1-3 TEETH PER QUADRANT F 00157.35 07012013 99999999 D D4263 BONE REPLACEMENT GRAFT,FIRST SITE IN QUD F 00179.11 07012013 99999999 D D4264 BONE REPLACEMENT GRAFT,EACH ADDL SITE F 00179.11 07012013 99999999 D D4265 BIO MTRLS TO AID SOFT/OS REG M 00000.00 05012013 99999999 D D4266 GUIDED TISS REGEN RESORBLE M 00000.00 05012013 99999999 D D4267 GUIDED TISS REGEN NONRESORB M 00000.00 05012013 99999999 D D4270 PEDICLE SOFT TISSUE GRAFTS F 00388.94 07012013 99999999 D D4273 SUBEPITHELIAL CONNECTIVE TISSUE GRAFT M 00000.00 05012013 99999999 D D4275 SOFT TISSUE ALLOGRAFT F 00388.94 07012013 99999999 D D4276 CON TISSUE W PEDICLE GRAFT M 00000.00 01012013 99999999 D D4277 Free soft tissue grft proc,first tooth o F 00358.23 07012013 99999999 D D4278 Free soft tissue graft procedure, each a F 00286.84 07012013 99999999 D D4283 AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCE M 00000.00 01012016 99999999 D D4285 NON-AUTOGENOUS CONNECTIVE TISSUE GRAFT P M 00000.00 01012016 99999999 D D4286 REMOVE NON-RESORB BARRIER M 00000.00 01012023 99999999 D D4341 PERIODONTAL SCALING AND ROOT PLANING - P F 00102.35 07012013 99999999 D D4342 PERIODONTAL SCALING AND ROOT PLANING 1-3 F 00038.40 07012013 99999999 D D4346 SCALING IN PRESNCE OF GENERALIZED MOD OR F 00035.82 01012017 99999999 D D4355 Full mouth debridement F 00051.17 07012013 99999999 D D4381 ANTIMICROBIAL MEDICATION, PER TOOTH F 00079.28 07012013 99999999 D D4910 PREVENTIVE PERIODONTAL MAINTENANCE F 00061.41 07012018 99999999 D D4920 UNSCHEDULED DRESSING CHANGE, BY NONTREAT F 00016.37 07012013 99999999 D D4999 UNSPECIFIED PERIODONTAL PROCEDURE M 00000.00 06112012 99999999 D D5110 COMPLETE DENTURE - MAXILLARY F 00677.04 07012025 99999999 D D5120 COMPLETE DENTURE - MANDIBULAR F 00670.54 07012025 99999999 D D5130 IMMEDIATE DENTURE - MAXILLARY F 00716.12 07012025 99999999 D D5140 IMMEDIATE DENTURE - MANDIBULAR F 00651.01 07012025 99999999 D D5211 MAXILLARY PARTIAL DENTURE-RESIN BASE F 00325.49 07012025 99999999 D D5212 MANDIBULAR PARTIAL DENTURE-RESIN BASE F 00423.15 07012025 99999999 D D5213 MAXILLARY PARTIAL DENTURE,CAST METAL FRA F 00751.86 07012025 99999999 D D5214 MANDIBULAR PARTIAL DENTURE,CAST METAL F 00751.86 07012025 99999999 D D5225 MAX.PARTIAL DENTURE FLEXIBLE BASE F 00641.88 07012025 99999999 D D5226 MANDIBULAR PARTIAL FLEXIBLE BASE F 00641.88 07012025 99999999 D D5410 ADJUST COMPLETE DENTURE,MAXILLARY F 00026.04 07012025 99999999 D D5411 ADJUST COMPLETE DENTURE,MANDIBULAR F 00026.04 07012025 99999999 D D5421 ADJUST PARTIAL DENTURE,MAXILLARY F 00026.04 07012025 99999999 D D5422 ADJUST PARTIAL DENTURE,MANDIBULAR F 00026.04 07012025 99999999 D D5511 REPAIR BROKEN COMPLETE DENTURE BASE, MAN M 00000.00 01012018 99999999 D D5512 REPAIR BROKEN COMPLETE DENTURE BASE, MAX M 00000.00 01012018 99999999 D D5520 REPLACE MISSING/BROKEN TEETH, COMPL DENT F 00065.09 07012025 99999999 D D5611 REPAIR RESIN PARTIAL DENTURE BASE, MANDI M 00000.00 01012018 99999999 D D5612 REPAIR RESIN PARTIAL DENTURE BASE, MAXIL M 00000.00 01012018 99999999 D D5621 REPAIR CAST PARTIAL FRAMEWORK, MANDIBULA M 00000.00 01012018 99999999 D D5622 REPAIR CAST PARTIAL FRAMEWORK, MAXILLARY M 00000.00 01012018 99999999 D D5630 REPAIR OR REPLACE BROKEN CLASP F 00067.70 07012025 99999999 D D5640 REPLACE BROKEN TEETH PER TOOTH F 00063.71 07012025 99999999 D D5650 ADD TOOTH TO EXISTING PARTIAL DENTURE F 00087.25 07012025 99999999 D D5660 ADD CLASP TO EXISTING PARTIAL DENTURE F 00103.87 07012025 99999999 D D5710 REBASE COMPLETE MAXILL DENTURE F 00301.93 07012025 99999999 D D5711 REBASE COMPLETE MANDIB DENTURE F 00301.93 07012025 99999999 D D5720 REBASE MAX PARTIAL DENTURE M 00000.00 05012013 99999999 D D5721 REBASE MANDIB PARTIAL DENTURE M 00000.00 05012013 99999999 D D5730 RELINE COMPLETE MAXILL DENTURE,CHAIRSIDE F 00162.75 07012025 99999999 D D5731 RELINE COMPLETE MANDIB DENTURE,CHAIRSIDE F 00143.21 07012025 99999999 D D5740 RELINE UPPER PARTIAL DENTURE, CHAIRSIDE F 00110.66 07012025 99999999 D D5741 RELINE LOWER PARTIAL DENTURE, CHAIRSIDE F 00130.20 07012025 99999999 D D5750 RELINE COMPLETE UPPER DENTURE, LABORATOR F 00208.33 07012025 99999999 D D5751 RELINE COMPLETE LOWER DENTURE, LABORATOR F 00208.33 07012025 99999999 D D5760 RELINE UPPER PARTIAL DENTURE, LABORATORY F 00195.31 07012025 99999999 D D5761 RELINE LOWER PARTIAL DENTURE, LABORATORY F 00195.31 07012025 99999999 D D5765 SOFT LINER FOR COMPLETE OR PARTIAL REMOV F 00152.98 07012025 99999999 D D5850 TISSUE CONDITIONING,MAXILLARY F 00039.05 07012025 99999999 D D5851 TISSUE CONDITIONING,MANDIBULAR F 00039.05 07012025 99999999 D D5862 PRECISION ATTACHMENT - 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INCLUDES PLACEMENT F 00552.00 07012013 99999999 D D6058 ABUTMENT SUPPORT PORCELAIN/CERAMIC CROWN F 00775.79 07012013 99999999 D D6059 ABUTMENT SUPPORT PORCELAIN FUSED METAL M 00000.00 06112012 99999999 D D6060 ABUTMENT SUPPORTPORCELAIN FUSED METAL M 00000.00 06112012 99999999 D D6061 ABUTMENT SUPPORTED NOBLE METAL CROWN F 00725.05 07012013 99999999 D D6062 ABUTMENT SUPPORTED CAST METAL CROWN M 00000.00 06112012 99999999 D D6063 ABUTMENT SUPPORTED CAST METAL CROWN M 00000.00 06112012 99999999 D D6064 ABUTMENT SUPPORTED CAST METAL CROWN M 00000.00 06112012 99999999 D D6065 IMPLANT SUPPORT PORCELAIN/CERAMIC CROWN M 00000.00 06112012 99999999 D D6066 IMPLANT SUPPORT PORCELAIN FUSED TO METAL M 00000.00 06112012 99999999 D D6067 IMPLANT SUPPORTED METAL CROWN M 00000.00 06112012 99999999 D D6068 ABUTMENT SUPPORT RETAINER PORCEL/CERAMIC M 00000.00 06112012 99999999 D D6069 ABUTMENT SUPPORT RETAIN PORCELAIN FUSED M 00000.00 06112012 99999999 D D6070 ABUTMENT SUPPORT RETAINER PORCELAIN FUSE M 00000.00 06112012 99999999 D D6071 ABUTMENT SUPPORT RETAINER PORCELAIN FUSE F 00781.75 07012013 99999999 D D6072 ABUTMENT SUPPORTED RETAINER FOR CAST M 00000.00 06112012 99999999 D D6073 ABUTMENT SUPPORTED RETAINER FOR CAST M 00000.00 06112012 99999999 D D6074 ABUTMENT SUPPORTED RETAINER FOR CAST M 00000.00 06112012 99999999 D D6075 IMPLANT SUPPORT RETAINER FOR CERAMIC FPD M 00000.00 06112012 99999999 D D6076 IMPLANT SUPPORT RETAINER PORCELAIN FUSED M 00000.00 06112012 99999999 D D6077 IMPLANT SUPPORT RETAINER CAST METAL FPD M 00000.00 06112012 99999999 D D6080 IMPLANT MAINTENANCE PROCEDURES M 00000.00 06112012 99999999 D D6082 Implant supported crown - porcelain fuse M 00000.00 01012020 99999999 D D6083 Implant supported crown porcelain fuse M 00000.00 01012020 99999999 D D6084 Implant supported crown - porcelain fuse M 00000.00 01012020 99999999 D D6086 Implant supported crown - predominantly M 00000.00 01012020 99999999 D D6087 Implant supported crown - noble alloys M 00000.00 01012020 99999999 D D6088 Implant supported crown - titanium and t M 00000.00 01012020 99999999 D D6089 ACCESS/RETORQ IMPLANT SCREW M 00000.00 01012024 99999999 D D6090 REPAIR IMPLANT SUPPORTED PROSTHESIS RPT M 00000.00 06112012 99999999 D D6091 REPL SEMI/PRECISION ATTACH M 00000.00 06112012 99999999 D D6092 RECEMENT IMPLANT/ABUTMENT SUPPORT CROWN M 00000.00 07012019 99999999 D D6093 RECEMENT IMPLANT/ABUTMENT SUPPORT FIXED M 00000.00 07012019 99999999 D D6094 ABUTMENT SUPPORTED CROWN TITANIUM M 00000.00 06112012 99999999 D D6097 Implant supported crown - porcelain fuse M 00000.00 01012020 99999999 D D6098 Implant supported retainer - porcelain f M 00000.00 01012020 99999999 D D6099 Implant supported retainer for fpd - por M 00000.00 01012020 99999999 D D6100 SURG REMOVAL OF IMPLANT BODY M 00000.00 06112012 99999999 D D6101 Debridemnt of a periimplant defect&surfa F 00230.28 07012013 99999999 D D6102 Debridemnt&osseous contouring of a perii F 00276.74 07012013 99999999 D D6105 REMOVE IMPLANT BODY M 00000.00 01012023 99999999 D D6110 IMPLANT/ABUTMENT SUPPORTED REMOVABLE DEN M 00000.00 01012015 99999999 D D6111 IMPLANT/ABUTMENT SUPPORTED REMOVABLE DEN M 00000.00 01012015 99999999 D D6112 IMPLANT/ABUTMENT SUPPORTED REMOVABLE DEN M 00000.00 01012015 99999999 D D6113 IMPLANT/ABUTMENT SUPPORTED REMOVABLE DEN M 00000.00 01012015 99999999 D D6114 IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE M 00000.00 01012015 99999999 D D6115 IMPLANT/ABUTMENT SUPPORTED FIXED- MANDIB M 00000.00 01012015 99999999 D D6116 IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE M 00000.00 01012015 99999999 D D6117 IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE M 00000.00 01012015 99999999 D D6120 Implant supported retainer - porcelain f M 00000.00 01012020 99999999 D D6121 Implant supported retainer for metal fpd M 00000.00 01012020 99999999 D D6122 Implant supported retainer for metal fpd M 00000.00 01012020 99999999 D D6123 Implant supported retainer for metal fpd M 00000.00 01012020 99999999 D D6190 RADIOGRAPH/SURGICAL IMPLANT INDEX M 00000.00 06112012 99999999 D D6194 ABUTMENT SUPPORTED RETAINER CROWN TITANI M 00000.00 06112012 99999999 D D6195 Abutment supported retainer - porcelainf M 00000.00 01012020 99999999 D D6197 REPLACE MATERIAL PROSTHESIS M 00000.00 01012023 99999999 D D6199 UNSPECIFIED IMPLANT PROCEDURE, BY REPOR M 00000.00 06112012 99999999 D D6205 PONTIC-INDIRECT RESIN BASED COMPOSITE F 00164.55 07012013 99999999 D D6210 PONTIC, CAST HIGH NOBLE METAL F 00164.55 07012013 99999999 D D6211 PONTIC, CAST PREDOMINANTLY BASE METAL F 00152.82 07012013 99999999 D D6212 PONTIC, CAST NOBLE METAL F 00152.82 07012013 99999999 D D6240 PONTIC, PORCELAIN FUSED TO HIGH NOBLE ME F 00399.17 08012014 99999999 D D6241 PONTIC, PORCELAIN FUSED TO PREDOMINANTLY F 00234.72 08012014 99999999 D D6242 PONTIC, PORCELAIN UFSED TO NOBLE METAL F 00332.64 07012013 99999999 D D6243 PONTIC - PORCELAIN FUSED TO TITANIUM AND F 00399.17 01012020 99999999 D D6245 PONTIC, PORCELAIN/CERAMIC F 00399.17 07012013 99999999 D D6250 PONTIC, RESIN WITH HIGH NOBLE METAL F 00188.09 07012013 99999999 D D6251 PONTIC RESIN WITH PREDOMINANTLY BASE MET F 00164.55 07012013 99999999 D D6252 PONTIC RESIN WITH NOBLE METAL F 00164.55 07012013 99999999 D D6545 CAST METAL RETAINER,RESIN BANDED FIXED F 00102.35 07012013 99999999 D D6549 RESIN RETAINER - FOR RESIN BONDED FIXED M 00000.00 01012015 99999999 D D6710 CROWN-INDIRECT RESIN BASED COMPOSITE F 00153.53 07012013 99999999 D D6720 CROWN, RESIN WITH HIGH NOBLE METAL F 00188.09 07012013 99999999 D D6721 CROWN, RESIN WITH PREDOMINANTLY BASE MET F 00182.20 07012013 99999999 D D6722 CROWN, RESIN WITH NOBLE METAL F 00182.20 07012013 99999999 D D6740 RETAINER- CROWN- PORCELAIN/CERAMIC F 00423.73 02012014 99999999 D D6750 CROWN, PORCELAIN FUSED TO HIGH NOBLE MET F 00430.89 08012014 99999999 D D6751 CROWN, PORCELAIN FUSED TO PREDOMINATELY F 00288.01 08012014 99999999 D D6752 CROWN, PROCELAIN FUSED TO NOBLE METAL F 00342.88 07012013 99999999 D D6753 Retainer crown porcelain fused to tita F 00430.89 01012020 99999999 D D6780 THREE FOURTH CAST GOLD CROWN F 00170.43 07012013 99999999 D D6784 Retainer crown 3/4 - titanium and titani F 00170.43 01012020 99999999 D D6790 CROWN, FULL CAST HIGH NOBLE METAL F 00262.39 07012013 99999999 D D6791 CROWN, FULL CAST PREDOMINANTLY BASE META F 00212.47 07012013 99999999 D D6792 CROWN, FULL CAST NOBLE METAL F 00226.16 07012013 99999999 D D6920 CONNECTOR BAR M 00000.00 01012019 99999999 D D6930 RECEMENT FIXED PARTIAL DENTURE F 00046.05 07012013 99999999 D D6940 STRESS BREAKER F 00051.19 07012013 99999999 D D6950 PRECISION ATTACHMENT F 00102.38 07012013 99999999 D D6980 FIXED PARTIAL DENTURE REPAIR M 00000.00 07012019 99999999 D D6999 UNSPECIFIED FIXED PROSTHODONTIC PROCEDUR M 00000.00 06112012 99999999 D D7111 EXTRACTION, CORONAL REMNANTS-DECIDUOUS T F 00042.52 07012025 99999999 D D7140 EXTRACTION,ERUPTED TOOTH OR EXP.ROOT F 00055.18 07012025 99999999 D D7210 SURGICAL REMOVAL OF ERUPTED TOOTH F 00097.23 07012013 99999999 D D7220 REMOVAL OF IMPACTED TOOTH - SOFT TISSUE F 00138.17 07012013 99999999 D D7230 REMOVAL OF IMPACTED TOOTH - PARTIAL BONY F 00184.23 07012013 99999999 D D7240 REMOVAL OF IMPACTED TOOTH - BONY F 00214.92 07012013 99999999 D D7241 REMOVAL IMPACTED TOOTH COMPL BONY W/UNUS F 00191.38 07012013 99999999 D D7250 ROOT RECOVERY(SURGICAL REMOVAL OF RESIDU F 00100.30 07012013 99999999 D D7251 Coronectomy F 00214.92 07012013 99999999 1 D7251 Coronectomy M 00000.00 06112012 99999999 D D7260 OROANTRAL FISTULA CLOSURE F 00297.41 07012013 99999999 D D7261 PRIMARY CLOSURE OF A SINUS PERFORATION F 00297.41 07012013 99999999 D D7270 REPLANTATION OF TRAUMATICALLY AVULSED TO F 00117.54 07012013 99999999 D D7280 SURGICAL ACCESS OF AN ERUPTED TOOTH F 00240.52 01012019 99999999 D D7282 MOBILIZATION OF ERUPTED/MALPOSITIONED TO F 00248.46 07012013 99999999 D D7283 PLACE. DEVICE TO FACILITATE ERUPTION TOO M 00000.00 01012019 99999999 D D7284 EXC BIOPSY OF SALIV GLANDS F 00107.47 01012024 99999999 D D7285 BIOPSY OF ORAL TISSUE(HARD) F 00179.11 07012013 99999999 D D7286 BIOPSY OF ORAL TISSUE(SOFT) F 00107.47 07012013 99999999 D D7287 CYTOLOGY SAMPLE COLLECTION F 00003.26 07012013 99999999 D D7295 HARVEST OF BONE FOR GRAFTING F 00707.39 07012013 99999999 1 D7295 HARVEST OF BONE M 00000.00 06112012 99999999 D D7310 ALVEOLOPLASTY W EXTRACTIONS, 4 OR MORE F 00085.40 07012013 99999999 D D7311 ALEVEOLPLASTY W/EXTRACTIONS, 1-3 TEETH P F 00085.40 07012013 99999999 D D7320 ALVEOLOPLASTY PER QUAD-NOT W/EXTRACTIONS F 00097.23 01012019 99999999 D D7321 ALVEOLOPLASTY NOT W/EXTRACTIONS, 1-3 TEE F 00097.23 01012019 99999999 D D7340 VESTIBULOPLASTY, RIDGE EXTEN. 2NDARY EPI F 00767.64 07012013 99999999 D D7350 VESTIBULOPLASTY--COMPLICATED F 01023.51 07012013 99999999 D D7410 EXCISION OF BENIGN LESION UP TO 1.25 CM F 00230.29 07012013 99999999 D D7411 EXCISION OF BENIGN LESION >1.25 CM F 00184.23 07012013 99999999 D D7412 EXCISION OF BENIGN LESION COMPLICATED F 00202.65 07012013 99999999 D D7413 EXCISION MALIGNANT LESION UP TO 1.25CM F 00176.60 07012013 99999999 D D7414 EXCISION OF MALIGNANT LESION >1.25CM F 00202.11 07012013 99999999 D D7415 EXCISION OF MALIGNANT LESION COMPLICATED F 00222.32 07012013 99999999 D D7440 EXCISION MALIGNANT TUMOR-UP TO 1.25 CM F 00110.65 07012013 99999999 D D7441 EXCISION MALIGNANT TUMOR-OVER 1.25 CM F 00127.38 07012013 99999999 D D7450 REMOVE ODONTOGENIC CYST/TUMOR-UP TO 1.25 F 00105.79 01012019 99999999 D D7451 REMOVE ODONTOGENIC CYST/TUMOR-OVER 1.25 F 00230.29 01012019 99999999 D D7460 REMOVAL OF NON-ONDONTOGENIC CYST/TUMOR-U F 00110.65 07012013 99999999 D D7461 REMOVAL OF NON-ONDONTOGENIC CYST/TUMOR-O F 00230.29 07012013 99999999 D D7465 DESTRUCTION OF LESIONS BY PHYSICAL METHO F 00153.53 07012013 99999999 D D7471 REMOVAL OF EXOSTOSIS, PER SITE F 00119.74 01012019 99999999 D D7472 REMOVAL OF TORUS PALATINUS F 00119.74 01012019 99999999 D D7473 REMOVAL OF TORUS MANDIBULARIS F 00119.74 01012019 99999999 D D7485 SURGICAL REDUCTION OF OSSEOUS TUBEROSITY F 00158.09 01012019 99999999 D D7490 RADICAL RESECTION OF MANDIBLE/BONE GRAFT M 00000.00 06112012 99999999 D D7509 MARSUPIALIZATION ODON CYST M 00000.00 01012023 99999999 D D7510 INCISION AND DRAINAGE OF ABSCESS-INTRAOR F 00053.22 07012013 99999999 D D7511 INCISION/DRAIN OF ABSCESS SOFT TISSUE F 00053.22 07012013 99999999 D D7520 INCISION AND DRAINAGE OF ABSCESS-EXTRAOR F 00230.29 07012013 99999999 D D7521 INCISION/DRAIN ABSCESS EXTRAORAL TISS F 00230.29 07012013 99999999 D D7530 REMOVAL OF FOREIGN BODY,SKIN,OR SUBCUTAN F 00094.03 07012013 99999999 D D7540 REMOVAL OF REACTION-PRODUCING FOREIGN BO F 00158.69 07012013 99999999 D D7550 PARTIAL OSTECTOMY/SEQUESTRECTOMY F 00156.59 07012013 99999999 D D7560 MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOT F 00255.87 07012013 99999999 D D7610 MAXILLA-OPEN REDUCTION,TEETH IMMOBILIZED F 03147.30 07012013 99999999 D D7620 MAXILLA-CLOSED REDUCTION,TEETH IMMOBILIZ F 00511.76 07012013 99999999 D D7630 MANDIBLE-OPEN REDUCTION,TEETH IMMOBILIZE F 01791.15 07012013 99999999 D D7640 MANDIBLE-CLOSED REDUCTION,TEETH IMMOBILI F 01125.86 07012013 99999999 D D7650 MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTI F 00499.57 07012013 99999999 D D7660 MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUC F 00340.88 07012013 99999999 D D7670 ALVEOLUS-STABILIZATION OF TEETH,OPEN RED F 00340.88 07012013 99999999 D D7671 ALVEOLUS OPEN REDUCTION,STABIL OF TEETH F 00409.41 07012013 99999999 D D7680 FACIAL BONES-COMPLICATED REDUCTION W/FIX F 00953.04 07012013 99999999 D D7710 MAXILLA-OPEN REDUCTION COMPOUND FRACTURE F 00764.06 07012013 99999999 D D7720 MAXILLA-CLOSED REDUCTION COMPOUND FRACTU F 00499.57 07012013 99999999 D D7730 MANDIBLE-OPEN REDUCTION COMPOUND FRACTUR F 01791.15 07012013 99999999 D D7740 MANDIBLE-CLOSED REDUCTION COMPOUND FRACT F 00499.57 07012013 99999999 D D7750 MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTI F 00499.57 07012013 99999999 D D7760 MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDU F 00235.08 07012013 99999999 D D7770 ALVEOLUS COMPOUND FRACTURE-STABILIZATION F 00409.41 07012013 99999999 D D7771 ALVEOLUS CLOSED REDUCTION STABIL.TEETH F 00340.88 07012013 99999999 D D7780 FACIAL BONES COMPOUND FRACTURE-COMPLICAT M 00000.00 06112012 99999999 D D7810 OPEN REDUCTION OF DISLOCATION F 01054.40 07012013 99999999 D D7820 CLOSED REDUCTION OF DISLOCATION F 00088.17 07012013 99999999 D D7830 MANIPULATION UNDER ANESTHESIA F 00088.17 07012013 99999999 D D7840 CONDYLECTOMY F 00948.56 07012013 99999999 D D7850 SURGICAL DISCECTOMY, WITH/WITHOUT IMPLAN F 00632.37 07012013 99999999 D D7860 ARTHROTOMY F 02047.02 07012013 99999999 D D7870 ARTHROCENTESIS F 00511.76 07012013 99999999 D D7880 OCCLUSAL ORTHOTIC DEVICE F 00308.32 01012019 99999999 D D7881 OCCLUSAL ORTHOTIC DEVICE ADJUSTMENT F 00040.00 01012016 99999999 D D7910 SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM F 00088.17 07012013 99999999 D D7911 COMPLICATED SUTURE UP TO 5 CM. F 00153.53 07012013 99999999 D D7912 COMPLICATED SUTURE OVER 5 CM. F 00286.57 07012013 99999999 D D7920 SKIN GRAFTS F 00707.39 07012013 99999999 D D7940 OSTEOPLASTY FOR ORTHOGNATHIC DEFORMITIES F 01580.92 07012013 99999999 D D7941 OSTEOTOMY, MANDIBULAR RAMI F 00948.56 07012013 99999999 D D7943 OSTEOTOMY, MANDIBULAR RAMI W BONE GRAFT F 00948.56 07012013 99999999 D D7944 OSTEOTOMY, SEGMENTED OR SUBAPICAL PER SE F 00981.68 07012013 99999999 D D7945 OSTEOTOMY, BODY OF MANDIBLE F 00948.56 07012013 99999999 D D7946 LEFORT I (MAXILLA, TOTAL) F 03582.30 07012013 99999999 D D7947 LEFORT I (MAXILLA SEGMENT) F 01580.92 07012013 99999999 D D7948 LEFORT II OR LEFORT III (OSTEOPLASTY FAC F 01580.92 07012013 99999999 D D7949 LEFORT II OR LEFORT III WITH BONE GRAFT F 01897.09 07012013 99999999 D D7950 OSSEOUS/PERIOSTEAL/CARTILAGE GRAFT AUTOG F 00948.56 07012013 99999999 D D7951 SINUS AUGMENTATION WITH BONE OR BONE SUB M 00000.00 09012012 99999999 D D7952 Sinus augmentation via a vertical approa M 00000.00 01012013 99999999 D D7953 BONE REPLACEMENT GRAFT FOR RIDGE PRESERV M 00000.00 06112012 99999999 D D7955 REPAIR MAXILLOFACIAL TISSUE DEFECT F 00707.39 07012013 99999999 D D7956 TISS REGEN EDENT RESORB M 00000.00 01012023 99999999 D D7957 TISS REGEN EDENT NONRESORB M 00000.00 01012023 99999999 D D7961 BUCCAL / LABIAL FRENECTOMY (FRENULECTOMY F 00127.94 01012021 99999999 D D7962 LINGUAL FRENECTOMY (FRENULECTOMY) F 00127.94 01012021 99999999 D D7963 FRENULOPLASTY M 00000.00 01012019 99999999 D D7970 EXCISION OF HYPERPLASTIC TISSUE-PER ARCH F 00097.23 01012019 99999999 D D7971 EXCISION OF PERICORONAL GINGIVA F 00097.23 01012019 99999999 D D7972 SURGICAL REDUCTION OF FIBROUS TUBEROSITY F 00097.23 01012019 99999999 D D7980 SIALOLITHOTOMY F 00235.08 07012013 99999999 D D7981 EXCISION OF SALIVARY GLAND F 00235.08 07012013 99999999 D D7982 SIALODOCHOPLASTY F 00235.08 07012013 99999999 D D7983 CLOSURE OF SALIVARY FISTULA F 00235.08 07012013 99999999 D D7990 EMERGENCY TRACHEOTOMY F 00235.08 07012013 99999999 D D7991 CORONOIDECTOMY F 00790.45 07012013 99999999 D D7995 SYNTHETIC GRAFT - MANDIBLE OR FACIAL BON M 00000.00 09012012 99999999 D D7998 INTRAORAL PLACE OF FIX DEV M 00000.00 06112012 99999999 1 D7998 INTRAORAL PLACE OF FIX DEV M 00000.00 06112012 99999999 D D8020 LIMITED ORTHODONTIC TREATMENT F 00298.11 07012021 99999999 D D8070 ORTHO TREAT OF TRANSITIONAL DENTITION F 01104.03 12012022 99999999 D D8080 COMPREHENSIVE ORTHODONTIC TREATMENT/ADOL F 03172.88 12012022 99999999 D D8210 REMOVABLE APPLIANCE THERAPY TO CONTROL H F 00153.53 07012013 99999999 D D8220 FIXED APPLIANCE THERAPY TO CONTROL HARMF F 00250.75 07012013 99999999 D D8680 ORTHODONTIC RETENTION F 00149.06 07012020 99999999 D D8701 Maxillary - Repair of fixed retainer F 00086.65 07012021 99999999 D D8702 Mandibular - Repair of fixed retainer F 00086.65 07012021 99999999 D D8703 Maxillary - Replacement of lost or broke F 00149.06 07012021 99999999 D D8704 Mandibular - Replacement of lost or brok F 00149.06 07012021 99999999 D D8999 UNSPECIFIED ORTHODONTIC PROCEDURE M 00000.00 06112012 99999999 D D9110 PALLIATIVE TX DENTAL PAIN F 00025.44 07012025 99999999 D D9120 FIXED PARTIAL DENTURE SECTIONING F 00049.73 01012019 99999999 D D9222 DEEP ANEST, 1ST 15 MIN F 00089.39 07012025 99999999 D D9223 GENERAL ANESTH EA ADDL 15 MI F 00086.11 07012025 99999999 D D9224 GEN ANES ADV AIR-15 MIN M 00000.00 01012026 99999999 D D9225 GEN ANES ADV AIR-SUB 15 MIN M 00000.00 01012026 99999999 D D9230 ANALGESIA F 00028.18 07012025 99999999 D D9239 IV MOD SEDATION, 1ST 15 MIN F 00078.70 07012025 99999999 D D9243 IV SEDATION EA ADDL 15M F 00077.51 07012025 99999999 D D9244 OFFICE MIN SED DRUG ENTERAL M 00000.00 01012026 99999999 D D9245 ADMIN MOD SEDATION-ENTERAL M 00000.00 01012026 99999999 D D9246 MOD SEDATION NONIV-15 MIN M 00000.00 01012026 99999999 D D9247 MOD SEDATION NONIV-SUB15MIN M 00000.00 01012026 99999999 D D9310 CONSULTATION-PER SESSION F 00025.59 07012013 99999999 D D9410 HOUSE CALL F 00025.95 07012025 99999999 D D9420 HOSP OR AMBULATORY SURG CENTER CALL F 00060.50 07012025 99999999 D D9440 OFFICE VISIT AFTER HOURS F 00036.65 07012025 99999999 D D9610 THERAPEUTIC DRUG INJECTION F 00014.68 07012025 99999999 D D9910 APPLY DESENSITIZING MEDICAMENTS F 00018.42 07012013 99999999 D D9930 COMPLICATIONS POST SURGERY M 00000.00 06112012 99999999 D D9942 REPAIR/RELINE OF OCCLUSAL GUARD M 00000.00 06112012 99999999 D D9943 OCCLUSAL GUARD ADJUSTMENT F 00040.00 01012016 99999999 D D9944 Occlusal guard - hard appliance, full ar F 00217.23 01012019 99999999 D D9946 Occlusal guard - hard appliance, partial F 00136.85 01012019 99999999 D D9995 TELEDENTISTRY- SYNCHRONOUS; REAL-TIME EN F 00000.00 01012024 99999999 D D9996 TELEDENTISTRY- ASYNCHRONOUS F 00000.00 01012024 99999999 D D9999 UNSPECIFIED DENTAL PROCEDURE M 00000.00 07012013 99999999 1 E0486 ORAL DEVICE/APPLIANCE CUSFAB M 00000.00 09012018 99999999 1 G2212 Prolong outpt/office vis F 00030.24 01012021 99999999 1 G2212 Prolong outpt/office vis X 00029.33 01012021 99999999 1 J0120 ACHROMYCIN, TETRACYCLINE INJECTION, UP T F 00012.44 07012013 99999999 1 J0162 INJ EPINEPHRINE (FRESENIUS) M 00000.00 01012026 99999999 1 J0163 Epinephrine in nacl (endo) M 00000.00 10012025 99999999 1 J0164 Epinephrine in nacl (baxter) M 00000.00 10012025 99999999 1 J0165 INJ EPINEPHRINE NOS 0.1 MG M 00000.00 07012025 99999999 1 J0167 INJ EPINEPHRINE (HOSPIRA) M 00000.00 07012025 99999999 1 J0168 INJ EPINEPHRINE (INTL MED SYS) M 00000.00 07012025 99999999 1 J0169 INJ EPINEPHRINE (ADRENALIN) M 00000.00 07012025 99999999 1 J0280 AMINOPHYLLIN INJECTION, 250 MG/10 ML F 00009.58 03012024 99999999 1 J0290 AMPICILLIN INJECTION, UP TO 500 MG F 00002.40 03012024 99999999 1 J0295 AMPICILLIN SODIUM/SULBACTAM SODIUM INJEC F 00005.06 03012024 99999999 1 J0330 INJECTION, ANECTINE, UP TO 20 MG F 00000.82 03012024 99999999 1 J0360 APRESOLINE HCL INJECTION, UP TO 20 MG F 00014.50 03012024 99999999 1 J0475 BACLOFEN INJECTION, 10 MG F 00157.76 05012024 99999999 1 J0670 CARBOCAINE INJECTION, UP TO 10 ML F 00002.44 03012024 99999999 1 J0688 INJ CEFAZOLIN SODIUM, HIKMA F 00001.49 01012024 99999999 1 J0689 Inj cefazolin sodium, baxter F 00002.51 11012023 99999999 1 J0690 INJ. CEFAZOLIN SODIUM 500 MG F 00002.03 03012024 99999999 1 J0692 INJECTION,CEFEPIME HCL, 500 MG F 00002.89 03012024 99999999 1 J0694 INJECTION, CEFOXITIN SODIUM, 1 GRAM F 00007.08 03012024 99999999 1 J0696 ROCEPHIN INJECTION - CEFTRIAXONE SODIUM, F 00001.01 03012024 99999999 1 J0697 STERILE CEFUROXIME SODIUM, ZINACOF, INJE F 00003.03 07012021 99999999 1 J0698 CEFOTAXIME SODIUM INJECTION, PER GM F 00009.93 05012024 99999999 1 J0701 Inj. cefepime hcl (baxter) F 00012.22 01012023 99999999 1 J0702 BETAMETHASONE ACETATE, BETAMETHASONE SOD F 00008.15 03012024 99999999 1 J0703 Inj, cefepime hcl (b braun) F 00008.76 03012024 99999999 1 J0720 CHLORMYCETIN SODIUM SUCCINATE INJECTION, F 00049.27 05012024 99999999 1 J0744 INJECTION CIPROFLOXACIN FOR IV,PER 200MG F 00003.04 03012024 99999999 1 J0780 COMPAZINE INJECTION, UP TO 10 MG F 00007.60 05012024 99999999 1 J0873 INJ, DAPTOMYCIN (XELLIA) F 00000.14 01012024 99999999 1 J0945 INJECTION BROMPHENIRAMINE PER 10MG F 00000.99 07012013 99999999 1 J1100 INJECTION DEXAMETHOSONE SOD. PHOS 1MG F 00000.19 11012022 99999999 1 J1165 DILANTIN, PHENYTOIN SODIUM, INJECTION F 00000.56 07012021 99999999 1 J1200 DIPHENHYDRAMINE HCL, BENA INJECTION, UP F 00001.42 05012024 99999999 1 J1364 ERYTHROMYCIN LACTOBIONATE INJECTION, PER F 00085.62 03012024 99999999 1 J1559 INJ, IMMUNE GLOBULIN (HIZENTRA),100 MG F 00021.73 03012024 99999999 1 J1566 IMMUNE GLOBULIN, POWDER F 00109.20 03012024 99999999 1 J1580 GARAMYCIN, GENTAMICIN INJECTION, UP TO F 00002.81 05012024 99999999 1 J1599 IMMUNE GLOBULIN, NON-LYOPHILIZED, NOS M 00000.00 06112012 99999999 1 J1630 HALDOL INJECTION, UP TO 5 MG F 00003.04 03012024 99999999 1 J1631 HALDOL DECANOATE INJECTION, PER 50 MG F 00022.52 03012024 99999999 1 J1700 HYDROCORTISONE ACETATE, BIOSONE, CORTEF F 00000.35 07012013 99999999 1 J1720 HYDROCORTISONE AS SODIUM SUCCINATE INJEC F 00014.57 05012024 99999999 1 J1730 INJECTION, DIAZOXIDE, UP TO 300 MG F 00129.73 07012013 99999999 1 J1790 INJECTION, INAPSIME, UP TO 5 MG F 00009.06 03012024 99999999 1 J1800 INDERAL INJECTION, UP TO 1 MG F 00009.15 03012024 99999999 1 J1885 KETOROLAC TROMETHAMINE, PER 15 MG (TORAD F 00001.50 03012024 99999999 1 J1990 LIBRIUM INJECTION, UP TO 100 MG F 00026.37 07012013 99999999 1 J2010 LINOCIN, LINCOMYCIN INJECTION, UP TO 300 F 00010.16 03012024 99999999 1 J2060 LORAZEPAM INJECTION, 2 MG (ATIVAN) F 00001.08 07012021 99999999 1 J2175 MEPERDINE, DEMEROL HCL, PER 100MG F 00002.94 05012024 99999999 1 J2180 MEPERGAN INJECTION, UP TO 50 MG F 00004.51 07012013 99999999 1 J2360 NORFLEX INJECTION, UP TO 60 MG F 00015.80 05012024 99999999 1 J2410 NUMORPHAN INJECTION, UP TO 1 MG F 00003.09 07012013 99999999 1 J2510 PENICILLIN, PROCAINE AQUEOUS INJECTION, F 00046.54 03012024 99999999 1 J2515 PENTOBARBITAL SODIUM INJECTION, 50 MG F 00053.50 03012024 99999999 1 J2540 INJECTION, PFIZERPEN, UP TO 600,000 F 00001.54 07012021 99999999 1 J2550 PHENERGAN INJECTION, UP TO 50 MG F 00003.75 03012024 99999999 1 J2560 PHENOBARBITAL INJECTION, UP TO 120 MG F 00040.92 07012024 99999999 1 J2650 PREDNISOLONE ACETATE, DUA-PRED, PANACORT F 00000.32 07012013 99999999 1 J2690 PRONESTYL INJECTION, UP TO 1 GM F 00348.24 03012024 99999999 1 J2700 PROSTAPHLIN INJECTION, UP TO 250 MG F 00002.95 05012024 99999999 1 J2765 REGLAN/METOCLOPRAMIDE HCL INJECTION, UP F 00002.23 05012024 99999999 1 J2770 INJECTION QUINUPRISTIN/DALFOPRISTIN,500 F 00471.97 07012021 99999999 1 J2800 ROBAXIN, METHOCARBAMOL, INJECTION UP TO F 00010.13 05012024 99999999 1 J2810 THEOPHYLLINE INJECTION, PER 40 MG F 00000.40 07012021 99999999 1 J3000 STREPTOMYCIN INJECTION, UP TO 1 GM F 00079.13 05012024 99999999 1 J3010 INJECTION, FENATYL CITRATE, 0.1MG F 00001.38 05012024 99999999 1 J3260 TOBRAMYCIN SULFATE, NEBCIN INJECTION, U F 00002.01 07012021 99999999 1 J3301 TRIAMCINOLONE ACETONIDE INJECT, 10 MG F 00002.45 07012021 99999999 1 J3302 TRIAMCINOLONE DIACETATE INJECTION, 5 MG F 00000.33 07012013 99999999 1 J3303 TRIAMCINOLONE HEXACETONIDE INJECTION, 5 F 00008.23 03012024 99999999 1 J3360 VALIUM, DIAZEPAM INJECTION, UP TO 5 MG F 00012.47 07012021 99999999 1 J3376 INJ VANCOMYCIN (HIKMA) 10MG M 00000.00 01012026 99999999 1 J3379 INJ, VALPROATE SOD, 5 MG M 00000.00 01012026 99999999 1 J3410 VISTARIL INJECTION, UP TO 25 MG F 00025.83 03012024 99999999 1 J3430 VITAMIN K INJECTION,PER 1MG F 00005.44 03012024 99999999 1 J3480 POTASIUM CHLORIDE INJECTION, PER 2MEQ F 00000.37 05012024 99999999 1 J3485 INJECTION, ZIDOVUDINE 10MG F 00001.48 07012021 99999999 1 J3490 UNCLASSIFIED DRUGS M 00000.00 06112012 99999999 1 J3520 ENDRATE DISODIUM PER 150MG F 00001.07 09012018 99999999 1 T1013 SIGN LANGUAGE OR ORAL INTERP SERVICES F 00014.77 07012013 99999999 D T1013 SIGN LANGUAGE OR ORAL INTERP SERVICES F 00014.77 07012013 99999999 U T1013 TELEPHONIC INTERPRETIVE SERVICES F 00001.67 UC 07012013 99999999 1 00100 ANES PX SALIVARY GLAND W/BX A 00075.00 06112012 99999999 1 00102 ANES PX PLSTC RPR CLEFT LIP A 00090.00 06112012 99999999 1 00160 ANES PX NOSE&SINUS NOS A 00075.00 06112012 99999999 1 00162 ANES PX NOSE&SINUS RAD SURG A 00105.00 06112012 99999999 1 00164 ANES PX NOSE&SINS BX SFT TIS A 00060.00 06112012 99999999 1 00170 ANES INTRAORAL PX NOS A 00075.00 06112012 99999999 1 00190 ANES PX FACIAL B1/SKULL NOS A 00075.00 06112012 99999999 1 00192 ANES PX FCL B1/SKL RAD SURG A 00105.00 06112012 99999999 1 00300 ANES ALL PX INTEG H/N/PTRUNK A 00075.00 06112012 99999999 1 10021 FNA BX W/O IMG GDN 1ST LES X 00046.30 01012018 99999999 1 10021 FNA BX W/O IMG GDN 1ST LES F 00082.92 07012013 99999999 1 10030 GUIDE CATHET FLUID DRAINAGE X 00171.45 01012018 99999999 1 10030 GUIDE CATHET FLUID DRAINAGE F 00683.93 01012014 99999999 1 10060 DRAINAGE OF SKIN ABSCESS X 00058.53 01012018 99999999 1 10060 DRAINAGE OF SKIN ABSCESS F 00072.69 07012013 99999999 1 10061 DRAINAGE OF SKIN ABSCESS X 00113.87 01012018 99999999 1 10061 DRAINAGE OF SKIN ABSCESS F 00133.43 10012014 99999999 1 10140 INCISION & DRAINAGE HEMATOMA, SEROMA OR X 00062.16 01012018 99999999 1 10140 INCISION & DRAINAGE HEMATOMA, SEROMA OR F 00088.01 07012013 99999999 1 10160 PUNCTURE DRAINAGE OF LESION F 00076.33 05012020 99999999 1 10160 PUNCTURE DRAINAGE OF LESION X 00054.72 05012020 99999999 1 10180 COMPLEX DRAINAGE WOUND X 00089.62 01012018 99999999 1 10180 COMPLEX DRAINAGE WOUND F 00127.35 07012013 99999999 1 11000 DEBRIDEMENT EXTENSIVE ECZEMATOUS/INFECTE F 00038.39 07012013 99999999 1 11000 DEBRIDEMENT EXTENSIVE ECZEMATOUS/INFECTE X 00019.82 01012018 99999999 1 11001 DEBRIDE INFECTED SKIN ADD-ON X 00013.69 01012018 99999999 1 11001 DEBRIDE INFECTED SKIN ADD-ON F 00020.83 07012013 99999999 1 11010 DEBRIDE SKIN AT FX SITE F 00270.57 07012013 99999999 1 11010 DEBRIDE SKIN AT FX SITE X 00148.65 01012018 99999999 1 11011 DEBRIDE SKIN MUSC AT FX SITE X 00181.10 01012018 99999999 1 11011 DEBRIDE SKIN MUSC AT FX SITE F 00334.46 07012013 99999999 1 11012 DEB SKIN BONE AT FX SITE F 00461.88 07012013 99999999 1 11012 DEB SKIN BONE AT FX SITE X 00270.74 01012018 99999999 1 11042 DEB SUBQ TISSUE 20 SQ CM/< X 00035.34 01012018 99999999 1 11042 DEB SUBQ TISSUE 20 SQ CM/< F 00068.18 07012013 99999999 1 11043 DEB MUSC/FASCIA 20 SQ CM/< F 00162.85 07012013 99999999 1 11043 DEB MUSC/FASCIA 20 SQ CM/< X 00108.48 01012018 99999999 1 11044 DEB BONE 20 SQ CM/< X 00157.81 01012018 99999999 1 11044 DEB BONE 20 SQ CM/< F 00218.92 07012013 99999999 1 11045 DEB SUBQ TISSUE ADD-ON F 00028.01 05012020 99999999 1 11045 DEB SUBQ TISSUE ADD-ON X 00017.51 05012020 99999999 1 11046 DEB MUSC/FASCIA ADD-ON X 00036.84 05012020 99999999 1 11046 DEB MUSC/FASCIA ADD-ON F 00048.95 05012020 99999999 1 11047 DEB BONE ADD-ON F 00080.28 05012020 99999999 1 11047 DEB BONE ADD-ON X 00062.97 05012020 99999999 1 11200 REMOVAL OF SKIN TAGS <W/15 F 00053.74 10012014 99999999 1 11200 REMOVAL OF SKIN TAGS <W/15 X 00043.31 01012018 99999999 1 11201 REMOVE SKIN TAGS ADD-ON X 00018.05 01012018 99999999 1 11201 REMOVE SKIN TAGS ADD-ON F 00020.80 07012013 99999999 1 11305 SHAVE SKIN LESION 0.5 CM/< F 00047.50 05012020 99999999 1 11305 SHAVE SKIN LESION 0.5 CM/< X 00018.55 05012020 99999999 1 11306 SHAVE SKIN LESION 0.6-1.0 CM X 00028.14 01012018 99999999 1 11306 SHAVE SKIN LESION 0.6-1.0 CM F 00066.83 07012013 99999999 1 11307 SHAVE SKIN LESION 1.1-2.0 CM F 00078.17 07012013 99999999 1 11307 SHAVE SKIN LESION 1.1-2.0 CM X 00035.61 01012018 99999999 1 11308 SHAVE SKIN LESION >2.0 CM X 00047.28 01012018 99999999 1 11308 SHAVE SKIN LESION >2.0 CM F 00097.60 07012013 99999999 1 11310 SHAVE SKIN LESION 0.5 CM/< F 00057.92 07012013 99999999 1 11310 SHAVE SKIN LESION 0.5 CM/< X 00023.75 01012018 99999999 1 11311 SHAVE SKIN LESION 0.6-1.0 CM X 00042.97 01012018 99999999 1 11311 SHAVE SKIN LESION 0.6-1.0 CM F 00074.27 07012013 99999999 1 11312 SHAVE SKIN LESION 1.1-2.0 CM F 00085.60 07012013 99999999 1 11312 SHAVE SKIN LESION 1.1-2.0 CM X 00040.86 01012018 99999999 1 11313 SHAVE SKIN LESION >2.0 CM X 00059.42 01012018 99999999 1 11313 SHAVE SKIN LESION >2.0 CM F 00111.99 07012013 99999999 1 11420 EXC H-F-NK-SP B9+MARG 0.5/< F 00081.64 07012013 99999999 1 11420 EXC H-F-NK-SP B9+MARG 0.5/< X 00053.00 01012018 99999999 1 11421 EXC H-F-NK-SP B9+MARG 0.6-1 X 00074.06 01012018 99999999 1 11421 EXC H-F-NK-SP B9+MARG 0.6-1 F 00108.17 07012013 99999999 1 11422 EXC H-F-NK-SP B9+MARG 1.1-2 F 00123.60 05012020 99999999 1 11422 EXC H-F-NK-SP B9+MARG 1.1-2 X 00093.54 05012020 99999999 1 11423 EXC H-F-NK-SP B9+MARG 2.1-3 X 00115.01 01012018 99999999 1 11423 EXC H-F-NK-SP B9+MARG 2.1-3 F 00151.11 07012013 99999999 1 11424 EXC H-F-NK-SP B9+MARG 3.1-4 F 00171.96 07012013 99999999 1 11424 EXC H-F-NK-SP B9+MARG 3.1-4 X 00129.33 01012018 99999999 1 11426 EXC H-F-NK-SP B9+MARG >4 CM X 00189.74 01012018 99999999 1 11426 EXC H-F-NK-SP B9+MARG >4 CM F 00235.36 07012013 99999999 1 11440 EXC FACE-MM B9+MARG 0.5 CM/< F 00097.10 07012013 99999999 1 11440 EXC FACE-MM B9+MARG 0.5 CM/< X 00072.37 01012018 99999999 1 11441 EXC FACE-MM B9+MARG 0.6-1 CM X 00090.97 01012018 99999999 1 11441 EXC FACE-MM B9+MARG 0.6-1 CM F 00118.96 07012013 99999999 1 11442 EXC FACE-MM B9+MARG 1.1-2 CM F 00134.74 07012013 99999999 1 11442 EXC FACE-MM B9+MARG 1.1-2 CM X 00101.57 01012018 99999999 1 11443 EXC FACE-MM B9+MARG 2.1-3 CM X 00133.61 01012018 99999999 1 11443 EXC FACE-MM B9+MARG 2.1-3 CM F 00171.77 07012013 99999999 1 11444 EXC FACE-MM B9+MARG 3.1-4 CM F 00214.78 07012013 99999999 1 11444 EXC FACE-MM B9+MARG 3.1-4 CM X 00169.63 01012018 99999999 1 11446 EXC FACE-MM B9+MARG >4 CM X 00218.71 01012018 99999999 1 11446 EXC FACE-MM B9+MARG >4 CM F 00268.11 07012013 99999999 1 11620 EXC H-F-NK-SP MAL+MARG 0.5/< F 00115.40 07012013 99999999 1 11620 EXC H-F-NK-SP MAL+MARG 0.5/< X 00070.21 01012018 99999999 1 11621 EXC S/N/H/F/G MAL+MRG 0.6-1 X 00094.84 01012018 99999999 1 11621 EXC S/N/H/F/G MAL+MRG 0.6-1 F 00148.42 07012013 99999999 1 11622 EXC S/N/H/F/G MAL+MRG 1.1-2 F 00173.02 07012013 99999999 1 11622 EXC S/N/H/F/G MAL+MRG 1.1-2 X 00113.33 01012018 99999999 1 11623 EXC S/N/H/F/G MAL+MRG 2.1-3 X 00139.39 01012018 99999999 1 11623 EXC S/N/H/F/G MAL+MRG 2.1-3 F 00201.26 07012013 99999999 1 11624 EXC S/N/H/F/G MAL+MRG 3.1-4 F 00236.63 07012013 99999999 1 11624 EXC S/N/H/F/G MAL+MRG 3.1-4 X 00164.61 01012018 99999999 1 11626 EXC S/N/H/F/G MAL+MRG >4 CM X 00204.50 01012018 99999999 1 11626 EXC S/N/H/F/G MAL+MRG >4 CM F 00289.22 08012013 99999999 1 11640 EXC F/E/E/N/L MAL+MRG 0.5CM< X 00079.06 01012018 99999999 1 11640 EXC F/E/E/N/L MAL+MRG 0.5CM< F 00129.41 07012013 99999999 1 11641 EXC F/E/E/N/L MAL+MRG 0.6-1 F 00176.60 07012013 99999999 1 11641 EXC F/E/E/N/L MAL+MRG 0.6-1 X 00113.75 01012018 99999999 1 11642 EXC F/E/E/N/L MAL+MRG 1.1-2 X 00134.31 01012018 99999999 1 11642 EXC F/E/E/N/L MAL+MRG 1.1-2 F 00202.11 07012013 99999999 1 11643 EXC F/E/E/N/L MAL+MRG 2.1-3 F 00237.26 07012013 99999999 1 11643 EXC F/E/E/N/L MAL+MRG 2.1-3 X 00167.71 01012018 99999999 1 11644 EXC F/E/E/N/L MAL+MRG 3.1-4 X 00209.81 01012018 99999999 1 11644 EXC F/E/E/N/L MAL+MRG 3.1-4 F 00295.71 07012013 99999999 1 11646 EXC F/E/E/N/L MAL+MRG >4 CM X 00289.56 01012018 99999999 1 11646 EXC F/E/E/N/L MAL+MRG >4 CM F 00383.76 03012014 99999999 1 11900 INJECT SKIN LESIONS </W 7 X 00019.36 01012018 99999999 1 11900 INJECT SKIN LESIONS </W 7 F 00035.36 07012013 99999999 1 11901 INJECT SKIN LESIONS >7 F 00050.61 07012013 99999999 1 11901 INJECT SKIN LESIONS >7 X 00034.31 01012018 99999999 1 11950 SUBQ NJX FILLING MATRL 1CC/< X 00046.33 01012018 99999999 1 11950 SUBQ NJX FILLING MATRL 1CC/< F 00069.95 07012013 99999999 1 11951 SUBQ NJX FIL MATRL 1.1-5.0CC F 00088.53 07012013 99999999 1 11951 SUBQ NJX FIL MATRL 1.1-5.0CC X 00061.57 01012018 99999999 1 11952 SUBQ NJX FIL MATRL 5.1-10CC X 00087.62 01012018 99999999 1 11952 SUBQ NJX FIL MATRL 5.1-10CC F 00120.53 07012013 99999999 1 11954 SUBQ NJX FIL MATRL>10.0 CC F 00127.44 07012013 99999999 1 11954 SUBQ NJX FIL MATRL>10.0 CC X 00090.39 01012018 99999999 1 11960 INSERT TISSUE EXPANDER(S) F 00640.43 07012013 99999999 1 11970 REPLACEMENT OF TISSUE EXPANDER WITH PERM F 00488.17 07012013 99999999 1 11971 RMVL TIS XPNDR WO INSJ IMPLT F 00214.68 07012013 99999999 1 11971 RMVL TIS XPNDR WO INSJ IMPLT X 00141.98 01012018 99999999 1 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< X 00053.77 01012018 99999999 1 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< F 00112.59 07012013 99999999 1 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM X 00064.34 01012018 99999999 1 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM F 00123.88 10012014 99999999 1 12004 RPR S/N/AX/GEN/TRK7.6-12.5CM X 00081.72 01012018 99999999 1 12004 RPR S/N/AX/GEN/TRK7.6-12.5CM F 00147.75 07012013 99999999 1 12005 RPR S/N/A/GEN/TRK12.6-20.0CM F 00183.69 07012013 99999999 1 12005 RPR S/N/A/GEN/TRK12.6-20.0CM X 00105.00 01012018 99999999 1 12006 RPR S/N/A/GEN/TRK20.1-30.0CM X 00141.80 01012018 99999999 1 12006 RPR S/N/A/GEN/TRK20.1-30.0CM F 00240.14 07012013 99999999 1 12007 RPR S/N/AX/GEN/TRNK >30.0 CM F 00262.90 07012013 99999999 1 12007 RPR S/N/AX/GEN/TRNK >30.0 CM X 00168.76 01012018 99999999 1 12011 RPR F/E/E/N/L/M 2.5 CM/< X 00058.25 01012018 99999999 1 12011 RPR F/E/E/N/L/M 2.5 CM/< F 00119.61 10012014 99999999 1 12013 RPR F/E/E/N/L/M 2.6-5.0 CM F 00135.63 10012014 99999999 1 12013 RPR F/E/E/N/L/M 2.6-5.0 CM X 00066.12 01012018 99999999 1 12014 RPR F/E/E/N/L/M 5.1-7.5 CM X 00086.83 01012018 99999999 1 12014 RPR F/E/E/N/L/M 5.1-7.5 CM F 00161.08 07012013 99999999 1 12015 RPR F/E/E/N/L/M 7.6-12.5 CM F 00203.85 07012013 99999999 1 12015 RPR F/E/E/N/L/M 7.6-12.5 CM X 00114.76 01012018 99999999 1 12016 RPR FE/E/EN/L/M 12.6-20.0 CM X 00150.29 01012018 99999999 1 12016 RPR FE/E/EN/L/M 12.6-20.0 CM F 00247.32 07012013 99999999 1 12017 RPR FE/E/EN/L/M 20.1-30.0 CM F 00326.19 07012013 99999999 1 12018 RPR F/E/E/N/L/M >30.0 CM F 00398.76 07012013 99999999 1 12020 CLOSURE OF SPLIT WOUND F 00164.10 07012013 99999999 1 12020 CLOSURE OF SPLIT WOUND X 00107.94 01012018 99999999 1 12021 TREATMENT/SUPERFICIAL WOUND DEHISCENCE; X 00094.31 01012018 99999999 1 12021 TREATMENT/SUPERFICIAL WOUND DEHISCENCE; F 00113.99 07012013 99999999 1 12031 INTMD RPR S/A/T/EXT 2.5 CM/< F 00137.76 07012013 99999999 1 12031 INTMD RPR S/A/T/EXT 2.5 CM/< X 00087.15 01012018 99999999 1 12032 INTMD RPR S/A/T/EXT 2.6-7.5 X 00099.58 01012018 99999999 1 12032 INTMD RPR S/A/T/EXT 2.6-7.5 F 00157.10 07012013 99999999 1 12034 INTMD RPR S/TR/EXT 7.6-12.5 F 00186.68 07012013 99999999 1 12034 INTMD RPR S/TR/EXT 7.6-12.5 X 00121.79 01012018 99999999 1 12035 INTMD RPR S/A/T/EXT 12.6-20 X 00132.99 01012018 99999999 1 12035 INTMD RPR S/A/T/EXT 12.6-20 F 00214.86 07012013 99999999 1 12036 INTMD RPR S/A/T/EXT 20.1-30 F 00277.40 07012013 99999999 1 12036 INTMD RPR S/A/T/EXT 20.1-30 X 00180.14 01012018 99999999 1 12037 INTMD RPR S/TR/EXT >30.0 CM X 00212.53 01012018 99999999 1 12037 INTMD RPR S/TR/EXT >30.0 CM F 00318.15 07012013 99999999 1 12051 INTMD RPR FACE/MM 2.5 CM/< F 00158.91 07012013 99999999 1 12051 INTMD RPR FACE/MM 2.5 CM/< X 00103.73 01012018 99999999 1 12052 INTMD RPR FACE/MM 2.6-5.0 CM X 00121.52 01012018 99999999 1 12052 INTMD RPR FACE/MM 2.6-5.0 CM F 00178.26 07012013 99999999 1 12053 INTMD RPR FACE/MM 5.1-7.5 CM F 00199.22 07012013 99999999 1 12053 INTMD RPR FACE/MM 5.1-7.5 CM X 00123.67 01012018 99999999 1 12054 INTMD RPR FACE/MM 7.6-12.5CM X 00141.42 01012018 99999999 1 12054 INTMD RPR FACE/MM 7.6-12.5CM F 00233.06 07012013 99999999 1 12055 INTMD RPR FACE/MM 12.6-20 CM F 00294.44 07012013 99999999 1 12055 INTMD RPR FACE/MM 12.6-20 CM X 00188.90 01012018 99999999 1 12056 INTMD RPR FACE/MM 20.1-30.0 X 00255.40 01012018 99999999 1 12056 INTMD RPR FACE/MM 20.1-30.0 F 00376.71 07012013 99999999 1 12057 INTMD RPR FACE/MM >30.0 CM F 00417.25 07012013 99999999 1 12057 INTMD RPR FACE/MM >30.0 CM X 00299.19 01012018 99999999 1 13120 CMPLX RPR S/A/L 1.1-2.5 CM X 00135.49 01012018 99999999 1 13120 CMPLX RPR S/A/L 1.1-2.5 CM F 00203.86 07012013 99999999 1 13121 CMPLX RPR S/A/L 2.6-7.5 CM F 00271.75 07012013 99999999 1 13121 CMPLX RPR S/A/L 2.6-7.5 CM X 00167.55 01012018 99999999 1 13122 CMPLX RPR S/A/L ADDL 5 CM/> X 00051.63 01012018 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TRNFR S/A/L 10 SQ CM/< X 00365.93 01012018 99999999 1 14021 TIS TRNFR S/A/L 10.1-30 SQCM X 00515.98 01012018 99999999 1 14021 TIS TRNFR S/A/L 10.1-30 SQCM F 00636.70 07012013 99999999 1 14040 TIS TRNFR F/C/C/M/N/A/G/H/F F 00544.62 07012013 99999999 1 14040 TIS TRNFR F/C/C/M/N/A/G/H/F X 00443.93 01012018 99999999 1 14041 TIS TRNFR F/C/C/M/N/A/G/H/F X 00591.65 01012018 99999999 1 14041 TIS TRNFR F/C/C/M/N/A/G/H/F F 00729.70 07012013 99999999 1 14060 TIS TRNFR E/N/E/L 10 SQ CM/< F 00594.40 07012013 99999999 1 14060 TIS TRNFR E/N/E/L 10 SQ CM/< X 00506.13 01012018 99999999 1 14061 TIS TRNFR E/N/E/L10.1-30SQCM X 00662.91 01012018 99999999 1 14061 TIS TRNFR E/N/E/L10.1-30SQCM F 00822.35 07012013 99999999 1 15004 WOUND PREP F/N/HF/G F 00325.06 07012013 99999999 1 15004 WOUND PREP F/N/HF/G X 00214.98 01012018 99999999 1 15005 WND PREP F/N/HF/G ADDL CM F 00101.01 11012023 99999999 1 15005 WND PREP F/N/HF/G ADDL CM X 00072.37 11012023 99999999 1 15115 EPIDRM A-GRFT FACE/NCK/HF/G X 00195.95 01012018 99999999 1 15115 EPIDRM A-GRFT FACE/NCK/HF/G F 00230.01 07012013 99999999 1 15116 EPIDRM A-GRFT F/N/HF/G ADDL F 00230.01 05012020 99999999 1 15116 EPIDRM A-GRFT F/N/HF/G ADDL X 00203.53 05012020 99999999 1 15120 SKN SPLT A-GRFT FAC/NCK/HF/G X 00492.43 01012018 99999999 1 15120 SKN SPLT A-GRFT FAC/NCK/HF/G F 00612.62 07012013 99999999 1 15121 SKN SPLT A-GRFT F/N/HF/G ADD F 00181.49 07012013 99999999 1 15121 SKN SPLT A-GRFT F/N/HF/G ADD X 00113.90 01012018 99999999 1 15135 DERM AUTOGRAFT FACE/NCK/HF/G X 00197.16 01012018 99999999 1 15135 DERM AUTOGRAFT FACE/NCK/HF/G F 00230.01 07012013 99999999 1 15136 DERM AUTOGRAFT F/N/HF/G ADD F 00230.01 07012013 99999999 1 15136 DERM AUTOGRAFT F/N/HF/G ADD X 00208.12 01012018 99999999 1 15155 CULT SKIN GRAFT F/N/HF/G X 00206.89 01012018 99999999 1 15155 CULT SKIN GRAFT F/N/HF/G F 00230.01 07012013 99999999 1 15156 CULT SKIN GRFT F/N/HFG ADD F 00230.01 07012013 99999999 1 15156 CULT SKIN GRFT F/N/HFG ADD X 00210.61 01012018 99999999 1 15157 CULT EPIDERM GRFT F/N/HFG +% X 00206.20 01012018 99999999 1 15157 CULT EPIDERM GRFT F/N/HFG +% F 00230.01 07012013 99999999 1 15240 SKIN FULL GRFT FACE/GENIT/HF F 00592.45 07012013 99999999 1 15240 SKIN FULL GRFT FACE/GENIT/HF X 00499.52 01012018 99999999 1 15241 SKIN FULL GRAFT ADD-ON X 00080.34 01012018 99999999 1 15241 SKIN FULL GRAFT ADD-ON F 00136.01 07012013 99999999 1 15260 SKIN FULL GRAFT EEN & LIPS F 00654.58 07012013 99999999 1 15260 SKIN FULL GRAFT EEN & LIPS X 00545.81 01012018 99999999 1 15261 SKIN FULL GRAFT ADD-ON X 00102.44 01012018 99999999 1 15261 SKIN FULL GRAFT ADD-ON F 00160.19 07012013 99999999 1 15574 FORMATION DIRECT OR TUBED PEDICLE, FOREH F 00602.65 07012013 99999999 1 15574 FORMATION DIRECT OR TUBED PEDICLE, FOREH X 00495.74 01012018 99999999 1 15576 FORMATION DIRECT OR TUBED PEDICLE, EYELI X 00424.90 01012018 99999999 1 15576 FORMATION DIRECT OR TUBED PEDICLE, EYELI F 00520.26 07012013 99999999 1 15620 INTERMEDIATE DELAY ANY FLAP,PRIMARY DELA F 00267.11 07012013 99999999 1 15620 INTERMEDIATE DELAY ANY FLAP,PRIMARY DELA X 00194.15 01012018 99999999 1 15630 INTERMEDIATE DELAY ANY FLAP,PRIMARY DELA X 00206.14 01012018 99999999 1 15630 INTERMEDIATE DELAY ANY FLAP,PRIMARY DELA F 00278.79 07012013 99999999 1 15740 GRAFT; ISLAND PEDICLE FLAP F 00709.42 07012013 99999999 1 15740 GRAFT; ISLAND PEDICLE FLAP X 00582.46 01012018 99999999 1 15750 GRAFT; NEUROVASCULAR PEDICLE FLAP F 00784.09 07012013 99999999 1 15756 FREE MYO/SKIN FLAP MICROVASC F 02240.80 07012013 99999999 1 15757 FREE SKIN FLAP MICROVASC F 02243.34 07012013 99999999 1 15758 FREE FASCIAL FLAP MICROVASC F 02236.41 07012013 99999999 1 15760 COMPOSITE SKIN GRAFT F 00594.36 07012013 99999999 1 15760 COMPOSITE SKIN GRAFT X 00484.38 01012018 99999999 1 15770 GRAFT; DERMA-FAT-FASCIA F 00520.35 07012013 99999999 1 15780 DERMABRASION TOTAL FACE F 00411.97 07012013 99999999 1 15780 DERMABRASION TOTAL FACE X 00306.96 01012018 99999999 1 15781 DERMABRASION;SEGMENTAL,FACE X 00249.07 01012018 99999999 1 15781 DERMABRASION;SEGMENTAL,FACE F 00326.59 07012013 99999999 1 15786 ABRASION LESION SINGLE F 00115.05 07012013 99999999 1 15786 ABRASION LESION SINGLE X 00062.46 01012018 99999999 1 15787 ABRASION LESIONS ADD-ON X 00008.79 01012018 99999999 1 15787 ABRASION LESIONS ADD-ON F 00024.92 07012013 99999999 1 15788 CHEMICAL PEEL FACE EPIDERM F 00151.17 07012013 99999999 1 15788 CHEMICAL PEEL FACE EPIDERM X 00078.83 01012018 99999999 1 15789 CHEMICAL PEEL FACE DERMAL X 00220.71 01012018 99999999 1 15789 CHEMICAL PEEL FACE DERMAL F 00302.24 07012013 99999999 1 15820 REVISION OF LOWER EYELID F 00545.62 06012022 99999999 1 15820 REVISION OF LOWER EYELID X 00472.61 06012022 99999999 1 15821 BLEPHAROPLASTY,LOWER EYELID;WITH EXTENSI X 00504.64 06012022 99999999 1 15821 BLEPHAROPLASTY,LOWER EYELID;WITH EXTENSI F 00584.44 06012022 99999999 1 15822 BLEPHAROPLASTY, UPPER EYELID F 00434.93 06012022 99999999 1 15822 BLEPHAROPLASTY, UPPER EYELID X 00365.61 06012022 99999999 1 15823 BLEPHAROPLASTY,UPPER EYELID;WITH EXCESSI X 00504.93 06012022 99999999 1 15823 BLEPHAROPLASTY,UPPER EYELID;WITH EXCESSI F 00585.36 06012022 99999999 1 15838 EXCISE EXCESS SKIN FAT PAD F 00466.17 07012013 99999999 1 15851 Removal sutr/staple req anes F 00063.06 07012013 99999999 1 15851 Removal sutr/staple req anes X 00028.78 01012018 99999999 1 15852 DRESSING CHANGE(OTHER THAN BURNS)UNDER A F 00067.94 07012013 99999999 1 15853 Removal sutr/stapl xreq anes F 00009.91 01012023 99999999 1 15854 Removal sutr&stapl xreq anes F 00013.89 01012023 99999999 1 17000 DESTRUCT PREMALG LESION X 00036.57 01012018 99999999 1 17000 DESTRUCT PREMALG LESION F 00046.72 07012013 99999999 1 17003 DESTRUCT PREMALG LES 2-14 F 00012.24 07012013 99999999 1 17003 DESTRUCT PREMALG LES 2-14 X 00005.45 01012018 99999999 1 17004 DESTROY PREMAL LESIONS 15/> X 00122.96 01012018 99999999 1 17004 DESTROY PREMAL LESIONS 15/> F 00182.16 07012013 99999999 1 17106 DSTR CUT VSC PRLF LES<10SQCM F 00266.87 07012013 99999999 1 17106 DSTR CUT VSC PRLF LES<10SQCM X 00210.62 01012018 99999999 1 17107 DSTR CUT VSC PRLF LES10-50SQ X 00396.95 01012018 99999999 1 17107 DSTR CUT VSC PRLF LES10-50SQ F 00508.48 07012013 99999999 1 17108 DSTR CUT VSC PRLF LES>50SQCM F 00793.12 07012013 99999999 1 17108 DSTR CUT VSC PRLF LES>50SQCM X 00637.90 01012018 99999999 1 17110 DESTRUCTION B9 LES UP TO 14 X 00029.07 01012018 99999999 1 17110 DESTRUCTION B9 LES UP TO 14 F 00047.44 07012013 99999999 1 17111 DESTRUCTION B9 LESIONS 15/> F 00064.31 07012013 99999999 1 17111 DESTRUCTION B9 LESIONS 15/> X 00040.98 01012018 99999999 1 17250 CHEM CAUT OF GRANLTJ TISSUE F 00035.78 05012020 99999999 1 17250 CHEM CAUT OF GRANLTJ TISSUE X 00016.26 05012020 99999999 1 17270 DESTRUCTION OF SKIN LESIONS X 00062.68 01012018 99999999 1 17270 DESTRUCTION OF SKIN LESIONS F 00096.75 07012013 99999999 1 17271 DESTRUCTION OF SKIN LESIONS F 00111.46 07012013 99999999 1 17271 DESTRUCTION OF SKIN LESIONS X 00074.02 01012018 99999999 1 17272 DESTRUCTION OF SKIN LESIONS X 00088.62 01012018 99999999 1 17272 DESTRUCTION OF SKIN LESIONS F 00132.01 07012013 99999999 1 17273 DESTRUCTION OF SKIN LESIONS X 00103.61 01012018 99999999 1 17273 DESTRUCTION OF SKIN LESIONS F 00151.56 07012013 99999999 1 17274 DESTRUCTION OF SKIN LESIONS F 00186.88 07012013 99999999 1 17274 DESTRUCTION OF SKIN LESIONS X 00132.21 01012018 99999999 1 17276 DESTRUCTION OF SKIN LESIONS X 00159.97 01012018 99999999 1 17276 DESTRUCTION OF SKIN LESIONS F 00218.67 07012013 99999999 1 17280 DESTRUCTION OF SKIN LESIONS F 00095.43 07012013 99999999 1 17280 DESTRUCTION OF SKIN LESIONS X 00060.12 01012018 99999999 1 17281 DESTRUCTION OF SKIN LESIONS X 00087.95 01012018 99999999 1 17281 DESTRUCTION OF SKIN LESIONS F 00127.90 07012013 99999999 1 17282 DESTRUCTION OF SKIN LESIONS F 00150.87 07012013 99999999 1 17282 DESTRUCTION OF SKIN LESIONS X 00104.23 01012018 99999999 1 17283 DESTRUCTION OF SKIN LESIONS X 00134.32 01012018 99999999 1 17283 DESTRUCTION OF SKIN LESIONS F 00186.04 07012013 99999999 1 17284 DESTRUCTION OF SKIN LESIONS F 00220.20 07012013 99999999 1 17284 DESTRUCTION OF SKIN LESIONS X 00162.21 01012018 99999999 1 17286 DESTRUCTION OF SKIN LESIONS X 00224.59 01012018 99999999 1 17286 DESTRUCTION OF SKIN LESIONS F 00291.09 07012013 99999999 1 20100 EXPLORE WOUND NECK F 00566.83 07012013 99999999 1 20200 BIOPSY,MUSCLE; SUPERFICIAL F 00103.15 07012013 99999999 1 20200 BIOPSY,MUSCLE; SUPERFICIAL X 00045.90 01012018 99999999 1 20205 BIOPSY,MUSCLE; DEEP X 00097.52 01012018 99999999 1 20205 BIOPSY,MUSCLE; DEEP F 00187.02 07012013 99999999 1 20220 BIOPSY,BONE,TROCAR,NEEDLE; SUPERFICIAL F 00129.36 07012013 99999999 1 20220 BIOPSY,BONE,TROCAR,NEEDLE; SUPERFICIAL X 00055.11 01012018 99999999 1 20240 BONE BIOPSY OPEN SUPERFICIAL F 00216.72 10012014 99999999 1 20520 RMVL FB MUSC/TDN SIMPLE F 00157.31 07012013 99999999 1 20520 RMVL FB MUSC/TDN SIMPLE X 00110.50 01012018 99999999 1 20525 RMVL FB MUSC/TDN DEEP/COMP X 00131.71 01012018 99999999 1 20525 RMVL FB MUSC/TDN DEEP/COMP F 00261.48 07012013 99999999 1 20550 NJX 1 TENDON SHEATH/LIGAMENT F 00067.69 07012013 99999999 1 20550 NJX 1 TENDON SHEATH/LIGAMENT X 00049.39 01012018 99999999 1 20551 NJX 1 TENDON ORIGIN/INSJ X 00040.92 01012018 99999999 1 20551 NJX 1 TENDON ORIGIN/INSJ F 00058.96 07012013 99999999 1 20552 NJX 1/MLT TRIGGER POINT 1/2 F 00058.96 07012013 99999999 1 20552 NJX 1/MLT TRIGGER POINT 1/2 X 00039.97 01012018 99999999 1 20600 DRAIN/INJ JOINT/BURSA W/O US X 00038.28 01012018 99999999 1 20600 DRAIN/INJ JOINT/BURSA W/O US F 00052.67 07012013 99999999 1 20605 DRAIN/INJ JOINT/BURSA W/O US F 00058.02 05012020 99999999 1 20605 DRAIN/INJ JOINT/BURSA W/O US X 00042.43 05012020 99999999 1 20615 TREATMENT OF BONE CYST F 00156.13 07012013 99999999 1 20615 TREATMENT OF BONE CYST X 00102.51 01012018 99999999 1 20650 INSERT AND REMOVE BONE PIN X 00120.71 01012018 99999999 1 20650 INSERT AND REMOVE BONE PIN F 00164.50 07012013 99999999 1 20660 APPLY REM FIXATION DEVICE F 00150.62 07012013 99999999 1 20670 REMOVAL OF SUPPORT IMPLANT F 00158.82 07012013 99999999 1 20670 REMOVAL OF SUPPORT IMPLANT X 00060.08 01012018 99999999 1 20680 REMOVAL OF SUPPORT IMPLANT X 00171.29 01012018 99999999 1 20680 REMOVAL OF SUPPORT IMPLANT F 00256.19 07012013 99999999 1 20690 APPLY BONE FIXATION DEVICE F 00231.21 07012013 99999999 1 20692 APPLY BONE FIXATION DEVICE F 00400.35 05012014 99999999 1 20693 ADJUST BONE FIXATION DEVICE F 00435.63 07012013 99999999 1 20694 REMOVE BONE FIXATION DEVICE F 00324.38 07012013 99999999 1 20694 REMOVE BONE FIXATION DEVICE X 00251.88 01012018 99999999 1 20900 REMOVAL OF BONE FOR GRAFT X 00155.77 01012018 99999999 1 20900 REMOVAL OF BONE FOR GRAFT F 00352.16 07012013 99999999 1 20902 REMOVAL OF BONE FOR GRAFT F 00508.80 07012013 99999999 1 20910 CARTILAGE GRAFT; COSTOCHONDRAL F 00327.09 07012013 99999999 1 20912 REMOVE CARTILAGE FOR GRAFT F 00425.76 07012013 99999999 1 20920 REMOVAL OF FASCIA FOR GRAFT F 00356.04 07012013 99999999 1 20922 FASCIA LATA GRAFT;BY INCISION & AREA EXP F 00487.73 07012013 99999999 1 20922 FASCIA LATA GRAFT;BY INCISION & AREA EXP X 00393.43 01012018 99999999 1 20955 BONE GRAFT W/ MICROVASC ANASTOMO;FIB F 02580.73 07012013 99999999 1 20956 BONE GRAFT W/MICROVASC ANASTOMO;ILIAC F 02449.93 07012013 99999999 1 20957 BONE GRAFT W/MICROVASC ANASTOMO;METATA F 02382.38 07012013 99999999 1 20962 BONE GRAFT W/MICROVASC ANASTOM;OTHER F 02419.73 07012013 99999999 1 20969 FREE OSTEOQTANOUS FLAP W/MICROVASC;OTH F 02880.25 07012013 99999999 1 20970 BONE/SKIN GRAFT ILIAC CREST F 02825.31 07012013 99999999 1 20972 BONE/SKIN GRAFT METATARSAL F 02657.50 07012013 99999999 1 20973 BONE/SKIN GRAFT GREAT TOE F 02959.48 07012013 99999999 1 20999 Unlisted px muscskel general M 00000.00 06112012 99999999 1 21010 INCISION OF JAW JOINT F 00666.37 07012013 99999999 1 21015 RESECT FACE/SCALP TUM < 2 CM F 00401.19 07012013 99999999 1 21025 EXCISION OF BONE;MANDIBLE F 00567.59 07012013 99999999 1 21025 EXCISION OF BONE;MANDIBLE X 00467.77 01012018 99999999 1 21026 EXCISION OF FACIAL BONE(S) X 00253.40 01012018 99999999 1 21026 EXCISION OF FACIAL BONE(S) F 00320.51 07012013 99999999 1 21029 CONTOUR OF FACE BONE LESION F 00542.05 07012013 99999999 1 21029 CONTOUR OF FACE BONE LESION X 00439.18 01012018 99999999 1 21030 EXCISE MAX/ZYGOMA B9 TUMOR X 00303.58 01012018 99999999 1 21030 EXCISE MAX/ZYGOMA B9 TUMOR F 00387.11 07012013 99999999 1 21031 EXCISION OF TORUS MANDIBULARIS F 00240.13 07012013 99999999 1 21031 EXCISION OF TORUS MANDIBULARIS X 00174.31 01012018 99999999 1 21032 EXCISION OF MAXILLARY TORUS PALATINUS X 00172.37 01012018 99999999 1 21032 EXCISION OF MAXILLARY TORUS PALATINUS F 00243.36 07012013 99999999 1 21034 EXCISE MAX/ZYGOMA MAL TUMOR F 00891.20 07012013 99999999 1 21034 EXCISE MAX/ZYGOMA MAL TUMOR X 00766.08 01012018 99999999 1 21040 EXCISE MANDIBLE LESION X 00136.93 01012018 99999999 1 21040 EXCISE MANDIBLE LESION F 00175.48 07012013 99999999 1 21044 REMOVAL OF JAW BONE LESION F 00744.54 07012013 99999999 1 21045 EXTENSIVE JAW SURGERY F 01021.70 07012013 99999999 1 21046 REMOVE MANDIBLE CYST COMPLEX F 00810.19 07012013 99999999 1 21047 EXCISE LWR JAW CYST W/REPAIR F 01005.20 07012013 99999999 1 21048 REMOVE MAXILLA CYST COMPLEX F 00834.41 07012013 99999999 1 21049 EXCIS UPPR JAW CYST W/REPAIR F 00957.39 07012013 99999999 1 21050 REMOVAL OF JAW JOINT F 00794.97 07012013 99999999 1 21060 REMOVE JAW JOINT CARTILAGE F 00752.53 07012013 99999999 1 21070 REMOVE CORONOID PROCESS F 00527.13 07012013 99999999 1 21073 MANIP OF TMJ, THERAPEUTIC, REQ ANESTH F 00276.21 07012013 99999999 1 21073 MANIP OF TMJ, THERAPEUTIC, REQ ANESTH X 00176.77 01012018 99999999 1 21076 PREPARE FACE/ORAL PROSTHESIS X 00755.71 01012018 99999999 1 21076 PREPARE FACE/ORAL PROSTHESIS F 00925.71 07012013 99999999 1 21077 ORBITAL PROSTHESIS F 02329.90 07012013 99999999 1 21077 ORBITAL PROSTHESIS X 01911.62 01012018 99999999 1 21079 IMPRESSION AND CUSTOM PREPARATION; INTER X 01312.01 01012018 99999999 1 21079 IMPRESSION AND CUSTOM PREPARATION; INTER F 01617.09 07012013 99999999 1 21080 PREPARE FACE/ORAL PROSTHESIS F 01818.27 07012013 99999999 1 21080 PREPARE FACE/ORAL PROSTHESIS X 01461.13 01012018 99999999 1 21081 IMPRESSION & CUSTOM PREPARATION MANDIBUL X 01326.63 01012018 99999999 1 21081 IMPRESSION & CUSTOM PREPARATION MANDIBUL F 01657.16 07012013 99999999 1 21082 IMPRESSION & CUSTOM PREPAR. PALATAL AUGM F 01439.71 07012013 99999999 1 21082 IMPRESSION & CUSTOM PREPAR. PALATAL AUGM X 01143.87 01012018 99999999 1 21083 PREPARE FACE/ORAL PROSTHESIS X 01082.12 01012018 99999999 1 21083 PREPARE FACE/ORAL PROSTHESIS F 01397.31 07012013 99999999 1 21084 IMPRESSION & CUSTOM PREPAR. SPEECH AID P F 01631.56 07012013 99999999 1 21084 IMPRESSION & CUSTOM PREPAR. SPEECH AID P X 01274.31 01012018 99999999 1 21085 IMPRESSION & CUSTOM PREPAR. ORAL SURGICA X 00453.82 01012018 99999999 1 21085 IMPRESSION & CUSTOM PREPAR. ORAL SURGICA F 00621.41 07012013 99999999 1 21086 IMPRESSION & CUSTOM PREPAR. ARTICULAR PR F 01807.61 07012013 99999999 1 21086 IMPRESSION & CUSTOM PREPAR. ARTICULAR PR X 01474.94 01012018 99999999 1 21087 IMPRESSION & CUSTOM PREPAR. NASAL PROSTH X 01392.56 01012018 99999999 1 21087 IMPRESSION & CUSTOM PREPAR. NASAL PROSTH F 01720.30 07012013 99999999 1 21088 IMPRESSION & CUSTOM PREPAR. FACIAL PROST M 00000.00 06112012 99999999 1 21089 Unlisted maxlfcl prosth px M 00000.00 06112012 99999999 1 21100 MAXILLOFACIAL FIXATION X 00139.05 01012018 99999999 1 21100 MAXILLOFACIAL FIXATION F 00251.86 07012013 99999999 1 21110 APPLY INTERDENTAL FIX DEVICE,CONDIT OTHE F 00376.76 07012013 99999999 1 21110 APPLY INTERDENTAL FIX DEVICE,CONDIT OTHE X 00307.30 01012018 99999999 1 21116 INJECTION JAW JOINT X-RAY X 00044.72 01012018 99999999 1 21116 INJECTION JAW JOINT X-RAY F 00157.20 07012013 99999999 1 21120 GENIOPLASTY; AUGMENTATION (AUTOGRAFT,ALL F 00395.59 07012013 99999999 1 21120 GENIOPLASTY; AUGMENTATION (AUTOGRAFT,ALL X 00305.65 01012018 99999999 1 21121 RECONSTRUCTION OF CHIN X 00420.28 01012018 99999999 1 21121 RECONSTRUCTION OF CHIN F 00505.35 07012013 99999999 1 21122 RECONSTRUCTION OF CHIN F 00543.82 07012013 99999999 1 21123 GENIOPLASTY, SLIDING AUGMENTATION W/INTE F 00702.13 07012013 99999999 1 21125 AUGMENTATION LOWER JAW BONE F 00613.46 07012013 99999999 1 21125 AUGMENTATION LOWER JAW BONE X 00155.82 01012018 99999999 1 21127 AUGMENT MANDIB W/BONE GRFT, ONLAY/INTE X 00161.61 01012018 99999999 1 21127 AUGMENT MANDIB W/BONE GRFT, ONLAY/INTE F 00706.46 07012013 99999999 1 21137 REDUCTION FOREHEAD, CONTOURING ONLY F 00618.82 07012013 99999999 1 21138 REDUCTION FOREHEAD, CONTOURING APPLICAT F 00746.30 07012013 99999999 1 21139 REDUCTION FOREHEAD, CONTOURING & APPPLIC F 00908.03 07012013 99999999 1 21141 LEFORT I-1 PIECE W/O GRAFT F 01119.25 07012013 99999999 1 21142 LEFORT I-2 PIECE W/O GRAFT F 01184.97 07012013 99999999 1 21143 LEFORT I-3/> PIECE W/O GRAFT F 01179.86 07012013 99999999 1 21145 RECNSTRCT MIDFACE,LEFORT 1;1PC W/GRAFT F 01180.66 07012013 99999999 1 21146 LEFORT I-2 PIECE W/ GRAFT F 01224.50 07012013 99999999 1 21150 RCNSTJ MDFC LEFRTII ANT NTRU F 01493.12 07012013 99999999 1 21151 RECNSTRCT MIDFACE,LEFORT2;ANY DIRECTN F 01752.66 07012013 99999999 1 21154 LEFORT III W/O LEFORT I F 01834.98 07012013 99999999 1 21155 RECNSTRCT MIDFACE,LEFORT3;W/ LEFORT1 F 02049.90 07012013 99999999 1 21159 LEFORT III W/FHDW/O LEFORT I F 02567.91 07012013 99999999 1 21160 LEFORT III W/FHD W/ LEFORT I F 02730.48 07012013 99999999 1 21172 RECONSTRUCT ORBIT/FOREHEAD F 01648.20 07012013 99999999 1 21175 RECONSTRUCT. BIFRONTAL S/L ORBITAL RIMS F 02017.64 07012013 99999999 1 21179 RECONSTRUCT ENTIRE FOREHEAD F 01412.95 07012013 99999999 1 21180 RECONSTRUCT ENTIRE FOREHEAD F 01581.37 07012013 99999999 1 21181 RCNST CNTRG B9 TUM CRNL XTRC F 00629.89 07012013 99999999 1 21182 RECONSTRUCT CRANIAL BONE F 01998.00 07012013 99999999 1 21183 RECONSTRUCT CRANIAL BONE F 02153.67 07012013 99999999 1 21184 RECONSTRUCT CRANIAL BONE F 02417.97 07012013 99999999 1 21188 RECONSTRUCTION OF MIDFACE F 01389.49 07012013 99999999 1 21193 RECONSTRUCT. MANDIBULAR RAMI, HORIZ/VERT F 01036.23 07012013 99999999 1 21194 RECONST LWR JAW W/GRAFT F 01198.63 07012013 99999999 1 21195 RECONSTRUCT MANDIBULAR RAMI AND/OR BODY, F 01059.33 07012013 99999999 1 21196 RECONSTRUCT. MANDIBULAR RAMUS SAGGITAL S F 01162.84 07012013 99999999 1 21198 RECONSTR LWR JAW SEGMENT F 00983.86 07012013 99999999 1 21199 RECONSTR LWR JAW W/ADVANCE F 00935.21 07012013 99999999 1 21206 RECONSTRUCT UPPER JAW BONE F 00866.43 07012013 99999999 1 21208 OSTEOPLASTY,FACIAL BONES;AUGMENTATION F 00733.17 07012013 99999999 1 21208 OSTEOPLASTY,FACIAL BONES;AUGMENTATION X 00336.53 01012018 99999999 1 21209 OSTEOPLASTY, FACIAL BONES;REDUCTION X 00329.28 01012018 99999999 1 21209 OSTEOPLASTY, FACIAL BONES;REDUCTION F 00446.97 07012013 99999999 1 21210 GRAFT,BONE;NASAL,MAXILLARY & MOLAR AREAS F 00721.29 07012013 99999999 1 21210 GRAFT,BONE;NASAL,MAXILLARY & MOLAR AREAS X 00269.19 01012018 99999999 1 21215 GRAFT,BONE;NASAL,MASILLARY & MOLAR AREA, X 00167.79 01012018 99999999 1 21215 GRAFT,BONE;NASAL,MASILLARY & MOLAR AREA, F 00752.30 07012013 99999999 1 21230 GRAFT;RIB CARTILAGE,AUTOGENOUS,FACE,CHIN F 00740.15 07012013 99999999 1 21235 GRAFT;EAR CARTILAGE AUTOGRAFT TO NOSE OR F 00545.31 01012015 99999999 1 21235 GRAFT;EAR CARTILAGE AUTOGRAFT TO NOSE OR X 00415.76 01012018 99999999 1 21240 ARTHROPLASTY,TEMPOROMANDIBULAR JOINT,WIT F 00992.61 07012013 99999999 1 21242 ARTHROPLASTY,TEMPOROMANDIBULAR JOINT,WIT F 00933.95 07012013 99999999 1 21243 ARTHROPLASTY TEMPOROMANDIBULAR,W/PROSTHE F 01265.78 07012013 99999999 1 21244 RECONSTRUCTION OF MANDIBLE,EXTRAORAL,W/T F 00823.00 07012013 99999999 1 21245 PARTIAL RECONSTRUCTION MANDIBLE/MAXILLA, F 00805.50 07012013 99999999 1 21245 PARTIAL RECONSTRUCTION MANDIBLE/MAXILLA, X 00622.53 01012018 99999999 1 21246 RECONSTRUCTION OF JAW F 00785.65 07012013 99999999 1 21247 RECONSTRUCTION MANDIBULAR CONDYLE W/BONE F 01555.12 07012013 99999999 1 21248 RECONSTRUCTION OF JAW F 00794.04 07012013 99999999 1 21248 RECONSTRUCTION OF JAW X 00631.89 01012018 99999999 1 21249 RECONSTRUCTION OF JAW X 00947.09 01012018 99999999 1 21249 RECONSTRUCTION OF JAW F 01184.18 07012013 99999999 1 21255 RECONSTRUCTION OF ZYGOMATIC ARCH/GLENOID F 01128.76 07012013 99999999 1 21256 RECONSTRUCTION OF ORBIT F 01137.95 07012013 99999999 1 21260 REVISE EYE SOCKETS F 01072.09 07012013 99999999 1 21261 REVISE EYE SOCKETS F 01832.17 07012013 99999999 1 21263 PERIORBITAL OSTEOTOMIES;ORBITAL HYPERTEL F 01844.72 07012013 99999999 1 21267 REVISE EYE SOCKETS F 01199.84 07012013 99999999 1 21268 REVISE EYE SOCKETS F 01497.19 07012013 99999999 1 21270 MALAR AUGMENTATION, PROSTHETIC MATERL F 00689.99 07012013 99999999 1 21270 MALAR AUGMENTATION, PROSTHETIC MATERL X 00498.52 01012018 99999999 1 21275 REVISION ORBITOFACIAL BONES F 00745.99 07012013 99999999 1 21280 REVISION OF EYELID F 00443.32 07012013 99999999 1 21282 REVISION OF EYELID F 00278.89 07012013 99999999 1 21295 REVISION OF JAW MUSCLE/BONE F 00135.93 07012013 99999999 1 21296 REVISION OF JAW MUSCLE/BONE F 00297.24 07012013 99999999 1 21299 Unlisted cranfcl&maxlfcl px M 00000.00 06112012 99999999 1 21315 CLSD TX NSL FX MNPJ WO STBLJ X 00074.62 01012018 99999999 1 21315 CLSD TX NSL FX MNPJ WO STBLJ F 00138.77 07012013 99999999 1 21320 CLSD TX NSL FX W/MNPJ&STABLJ F 00180.21 07012013 99999999 1 21320 CLSD TX NSL FX W/MNPJ&STABLJ X 00092.98 01012018 99999999 1 21325 OPEN TX NOSE FX UNCOMPLICATD F 00269.79 07012013 99999999 1 21330 OPEN TX NOSE FX W/SKELE FIXJ F 00389.98 07012013 99999999 1 21335 OPEN TX NOSE & SEPTAL FX F 00605.17 07012013 99999999 1 21336 OPEN TX SEPTAL FX W/WO STABJ F 00371.44 07012013 99999999 1 21337 CLOSED TX SEPTAL&NOSE FX F 00230.76 07012013 99999999 1 21337 CLOSED TX SEPTAL&NOSE FX X 00164.22 01012018 99999999 1 21338 OPEN NASOETHMOID FX W/O FIXJ F 00426.90 07012013 99999999 1 21339 OPEN NASOETHMOID FX W/ FIXJ F 00535.27 07012013 99999999 1 21340 PERQ TX NASOETHMOID FX F 00705.83 07012013 99999999 1 21343 OPEN TX DPRSD FRONT SINUS FX F 00810.04 07012013 99999999 1 21344 OPEN TX COMPL FRONT SINUS FX F 01129.64 07012013 99999999 1 21345 CLOSED TX NOSE/JAW FX F 00572.24 07012013 99999999 1 21345 CLOSED TX NOSE/JAW FX X 00450.24 01012018 99999999 1 21346 OPN TX NASOMAX FX W/FIXJ F 00711.42 07012013 99999999 1 21347 OPN TX NASOMAX FX MULTPLE F 00813.64 07012013 99999999 1 21348 OPN TX NASOMAX FX W/GRAFT F 01001.03 07012013 99999999 1 21355 PERQ TX MALAR FRACTURE F 00229.72 07012013 99999999 1 21355 PERQ TX MALAR FRACTURE X 00168.21 01012018 99999999 1 21356 OPN TX DPRSD ZYGOMATIC ARCH X 00211.85 01012018 99999999 1 21356 OPN TX DPRSD ZYGOMATIC ARCH F 00288.13 07012013 99999999 1 21360 OPN TX DPRSD MALAR FRACTURE F 00457.08 07012013 99999999 1 21365 OPN TX COMPLX MALAR FX F 00961.79 07012013 99999999 1 21366 OPN TX COMPLX MALAR W/GRFT F 01078.77 07012013 99999999 1 21385 OPN TX ORBIT FX TRANSANTRAL F 00629.02 07012013 99999999 1 21386 OPN TX ORBIT FX PERIORBITAL F 00629.65 07012013 99999999 1 21387 OPN TX ORBIT FX COMBINED F 00627.30 07012013 99999999 1 21390 OPN TX ORBIT PERIORBTL IMPLT F 00713.82 07012013 99999999 1 21395 OPN TX ORBIT PERIORBT W/GRFT F 00804.99 07012013 99999999 1 21400 CLOSED TX ORBIT W/O MANIPULJ F 00130.84 07012013 99999999 1 21400 CLOSED TX ORBIT W/O MANIPULJ X 00104.01 01012018 99999999 1 21401 CLOSED TX ORBIT W/MANIPULJ X 00146.28 01012018 99999999 1 21401 CLOSED TX ORBIT W/MANIPULJ F 00242.07 07012013 99999999 1 21406 OPN TX ORBIT FX W/O IMPLANT F 00454.95 07012013 99999999 1 21407 OPN TX ORBIT FX W/IMPLANT F 00571.34 07012013 99999999 1 21408 OPN TX ORBIT FX W/BONE GRFT F 00780.89 07012013 99999999 1 21421 TREAT MOUTH ROOF FRACTURE F 00407.93 07012013 99999999 1 21421 TREAT MOUTH ROOF FRACTURE X 00335.46 01012018 99999999 1 21422 TREAT MOUTH ROOF FRACTURE F 00589.45 07012013 99999999 1 21423 TREAT MOUTH ROOF FRACTURE F 00690.74 07012013 99999999 1 21431 TREAT CRANIOFACIAL FRACTURE F 00464.85 07012013 99999999 1 21432 TREAT CRANIOFACIAL FRACTURE F 00575.18 07012013 99999999 1 21433 TREAT CRANIOFACIAL FRACTURE F 01541.72 07012013 99999999 1 21435 TREAT CRANIOFACIAL FRACTURE F 01091.92 07012013 99999999 1 21436 TREAT CRANIOFACIAL FRACTURE F 01599.33 07012013 99999999 1 21440 TREAT DENTAL RIDGE FRACTURE F 00236.96 07012013 99999999 1 21440 TREAT DENTAL RIDGE FRACTURE X 00187.17 01012018 99999999 1 21445 TREAT DENTAL RIDGE FRACTURE X 00324.68 01012018 99999999 1 21445 TREAT DENTAL RIDGE FRACTURE F 00412.23 07012013 99999999 1 21450 TREAT LOWER JAW FRACTURE F 00250.70 07012013 99999999 1 21450 TREAT LOWER JAW FRACTURE X 00200.23 01012018 99999999 1 21451 TREAT LOWER JAW FRACTURE X 00314.70 01012018 99999999 1 21451 TREAT LOWER JAW FRACTURE F 00384.77 07012013 99999999 1 21452 TREAT LOWER JAW FRACTURE F 00219.17 07012013 99999999 1 21452 TREAT LOWER JAW FRACTURE X 00124.74 01012018 99999999 1 21453 TREAT LOWER JAW FRACTURE X 00363.16 01012018 99999999 1 21453 TREAT LOWER JAW FRACTURE F 00435.33 07012013 99999999 1 21454 TREAT LOWER JAW FRACTURE F 00452.45 07012013 99999999 1 21461 TREAT LOWER JAW FRACTURE F 00595.10 07012013 99999999 1 21461 TREAT LOWER JAW FRACTURE X 00254.46 01012018 99999999 1 21462 TREAT LOWER JAW FRACTURE X 00316.99 01012018 99999999 1 21462 TREAT LOWER JAW FRACTURE F 00707.39 07012013 99999999 1 21465 TREAT LOWER JAW FRACTURE F 00719.03 07012013 99999999 1 21470 TREAT LOWER JAW FRACTURE F 01032.92 07012013 99999999 1 21480 RESET DISLOCATED JAW F 00062.77 07012013 99999999 1 21480 RESET DISLOCATED JAW X 00019.86 01012018 99999999 1 21485 RESET DISLOCATED JAW X 00197.92 01012018 99999999 1 21485 RESET DISLOCATED JAW F 00247.63 07012013 99999999 1 21490 REPAIR DISLOCATED JAW F 00676.54 07012013 99999999 1 21495 OPEN TREATMENT OF HYOID FRACTURE F 00388.07 07012013 99999999 1 21497 INTERDENTAL WIRING, FOR CONDITION OTHER F 00287.99 07012013 99999999 1 21497 INTERDENTAL WIRING, FOR CONDITION OTHER X 00236.60 01012018 99999999 1 21499 Unlisted muscskel px head M 00000.00 06112012 99999999 1 21501 DRAIN NECK/CHEST LESION X 00168.58 01012018 99999999 1 21501 DRAIN NECK/CHEST LESION F 00243.93 07012013 99999999 1 21550 BIOPSY,SOFT TISSUE OF NECK OR THORAX F 00128.75 07012013 99999999 1 21550 BIOPSY,SOFT TISSUE OF NECK OR THORAX X 00075.76 01012018 99999999 1 21555 EXC NECK LES SC < 3 CM X 00188.12 01012018 99999999 1 21555 EXC NECK LES SC < 3 CM F 00262.48 07012013 99999999 1 21556 EXC NECK TUM DEEP < 5 CM F 00335.21 01012015 99999999 1 21685 HYOID MYOTOMY & SUSPENSION F 00799.72 07012013 99999999 1 29800 JAW ARTHROSCOPY/SURGERY F 00436.86 07012013 99999999 1 29804 JAW ARTHROSCOPY/SURGERY F 00605.41 07012013 99999999 1 29999 Unlisted px arthroscopy M 00000.00 06112012 99999999 1 30000 DRAINAGE OF NOSE LESION X 00049.98 01012018 99999999 1 30000 DRAINAGE OF NOSE LESION F 00099.29 07012013 99999999 1 30020 DRAINAGE OF NOSE LESION F 00102.29 07012013 99999999 1 30020 DRAINAGE OF NOSE LESION X 00051.05 01012018 99999999 1 30120 EXCISION OR SURGICAL PLANING OF SKIN OF X 00318.35 01012018 99999999 1 30120 EXCISION OR SURGICAL PLANING OF SKIN OF F 00387.30 07012013 99999999 1 30124 REMOVAL OF NOSE LESION F 00189.44 07012013 99999999 1 30125 EXCISION DERMOID CYST,NOSE;COMPLEX,UNDER F 00466.03 07012013 99999999 1 30150 PARTIAL REMOVAL OF NOSE F 00612.58 07012013 99999999 1 30160 REMOVAL OF NOSE F 00678.12 07012013 99999999 1 30200 INJECTION TREATMENT OF NOSE F 00052.92 07012013 99999999 1 30200 INJECTION TREATMENT OF NOSE X 00027.13 01012018 99999999 1 30300 REMOVAL FOREIGN BODY,INTRANASAL;OFFICE T X 00048.47 01012018 99999999 1 30300 REMOVAL FOREIGN BODY,INTRANASAL;OFFICE T F 00083.25 10012014 99999999 1 30310 REMOVAL FOREIGN BODY,INTRANASAL;REQUIRIN F 00131.93 07012013 99999999 1 30400 RHINOPLASTY,PRIMARY;LATERAL AND ALAR CAR F 01140.76 06012022 99999999 1 30410 RECONSTRUCTION OF NOSE F 01310.27 06012022 99999999 1 30420 RHINOPLASTY,PRIMARY;INCLUDING MAJOR SEPT F 01352.67 06012022 99999999 1 30430 REVISION OF NOSE F 00999.12 06012022 99999999 1 30435 RHINOPLASTY, SECONDARY;INTERMEDIATE REVI F 01242.09 06012022 99999999 1 30450 RHINOPLASTY, SECONDARY;MAJOR REVISION F 01616.69 06012022 99999999 1 30460 REVISION OF NOSE F 00762.46 06012022 99999999 1 30462 REVISION OF NOSE F 01468.87 06012022 99999999 1 30465 REPAIR NASAL STENOSIS F 00806.71 07012013 99999999 1 30520 SEPTOPLASTY OR SUBMUCOUS RESECTION,WITH F 00627.29 06012022 99999999 1 30580 REPAIR UPPER JAW FISTULA F 00440.14 07012013 99999999 1 30580 REPAIR UPPER JAW FISTULA X 00336.65 01012018 99999999 1 30600 REPAIR FISTULA; ORONASAL X 00274.99 01012018 99999999 1 30600 REPAIR FISTULA; ORONASAL F 00363.04 07012013 99999999 1 30620 INTRANASAL RECONSTRUCTION F 00436.46 07012013 99999999 1 30630 REPAIR NASAL SEPTUM DEFECT F 00484.63 07012013 99999999 1 30801 ABLATION;INF TURBINATES;SUPERFICIAL F 00085.04 07012013 99999999 1 30801 ABLATION;INF TURBINATES;SUPERFICIAL X 00049.50 01012018 99999999 1 30802 ABLATE INF TURBINATE SUBMUC X 00087.29 01012018 99999999 1 30802 ABLATE INF TURBINATE SUBMUC F 00136.77 07012013 99999999 1 30901 CONTROL NASAL HEMORRHAGE,ANTERIOR SIMPLE F 00087.18 07012013 99999999 1 30901 CONTROL NASAL HEMORRHAGE,ANTERIOR SIMPLE X 00035.42 01012018 99999999 1 30903 CONTROL NASAL HEMORRHAGE,ANTERIOR,COMPLE X 00040.42 01012018 99999999 1 30903 CONTROL NASAL HEMORRHAGE,ANTERIOR,COMPLE F 00110.09 07012013 99999999 1 30905 CONTROL OF NOSEBLEED F 00172.20 07012013 99999999 1 30905 CONTROL OF NOSEBLEED X 00054.78 01012018 99999999 1 30906 REPEAT CONTROL OF NOSEBLEED X 00072.12 01012018 99999999 1 30906 REPEAT CONTROL OF NOSEBLEED F 00182.57 07012013 99999999 1 30930 FRACTURE NASAL INFERIOR TURBS, THERA F 00089.07 07012013 99999999 1 30999 Unlisted procedure nose M 00000.00 06112012 99999999 1 31020 EXPLORATION MAXILLARY SINUS X 00156.71 01012018 99999999 1 31020 EXPLORATION MAXILLARY SINUS F 00217.41 07012013 99999999 1 31030 EXPLORATION MAXILLARY SINUS F 00412.02 07012013 99999999 1 31030 EXPLORATION MAXILLARY SINUS X 00307.83 01012018 99999999 1 31032 EXPLORE SINUS REMOVE POLYPS F 00468.30 07012013 99999999 1 31080 REMOVAL OF FRONTAL SINUS F 00733.07 07012013 99999999 1 31081 REMOVAL OF FRONTAL SINUS F 00838.05 07012013 99999999 1 31084 REMOVAL OF FRONTAL SINUS F 00938.73 07012013 99999999 1 31085 REMOVAL OF FRONTAL SINUS F 00990.75 07012013 99999999 1 31086 REMOVAL OF FRONTAL SINUS F 00840.32 07012013 99999999 1 31087 REMOVAL OF FRONTAL SINUS F 00836.63 07012013 99999999 1 31225 MAXILLECTOMY;WITHOUT ORBITAL EXENTERATIO F 01306.67 07012013 99999999 1 31230 MAXILLECTOMY; WITH ORBITAL EXENTERATION( F 01481.00 07012013 99999999 1 31600 INCISION OF WINDPIPE F 00237.03 07012013 99999999 1 31603 INCISION OF WINDPIPE F 00265.96 07012013 99999999 1 31605 INCISION OF WINDPIPE F 00230.13 07012013 99999999 1 31830 REVISION OF TRACHEOSTOMY SCAR F 00355.05 07012013 99999999 1 31830 REVISION OF TRACHEOSTOMY SCAR X 00268.27 01012018 99999999 1 40490 BIOPSY OF LIP X 00047.01 01012018 99999999 1 40490 BIOPSY OF LIP F 00084.26 07012013 99999999 1 40500 VERMILIONECTOMY (LIP SHAVE),WITH MUCOSAL F 00326.77 07012013 99999999 1 40500 VERMILIONECTOMY (LIP SHAVE),WITH MUCOSAL X 00229.71 01012018 99999999 1 40510 PARTIAL EXCISION OF LIP X 00260.79 01012018 99999999 1 40510 PARTIAL EXCISION OF LIP F 00362.83 07012013 99999999 1 40520 EXCISION OF LIP;V-EXCISION W/PRIMARY DIR F 00360.73 07012013 99999999 1 40520 EXCISION OF LIP;V-EXCISION W/PRIMARY DIR X 00257.97 01012018 99999999 1 40525 RECONSTRUCT LIP WITH FLAP F 00551.89 07012013 99999999 1 40527 RECONSTRUCT LIP WITH FLAP F 00658.64 07012013 99999999 1 40530 RESECTION LIP,MORE THAN ONE-FOURTH,WITHO F 00387.90 07012013 99999999 1 40530 RESECTION LIP,MORE THAN ONE-FOURTH,WITHO X 00283.43 01012018 99999999 1 40650 REPAIR LIP,FULL THICKNESS;VERMILION ONLY X 00189.02 01012018 99999999 1 40650 REPAIR LIP,FULL THICKNESS;VERMILION ONLY F 00284.20 07012013 99999999 1 40652 REPAIR LIP,FULL THICKNESS;UP TO HALF VER F 00338.48 07012013 99999999 1 40652 REPAIR LIP,FULL THICKNESS;UP TO HALF VER X 00237.51 01012018 99999999 1 40654 REPAIR LIP,FULL THICKNESS;OVER ONE HALF X 00297.23 01012018 99999999 1 40654 REPAIR LIP,FULL THICKNESS;OVER ONE HALF F 00408.21 07012013 99999999 1 40700 REPAIR CLEFT LIP/NASAL F 00786.05 07012013 99999999 1 40701 REPAIR CLEFT LIP/NASAL F 01123.45 07012013 99999999 1 40702 REPAIR CLEFT LIP/NASAL F 00802.90 07012013 99999999 1 40720 REPAIR CLEFT LIP/NASAL F 00858.70 07012013 99999999 1 40761 REPAIR CLEFT LIP/NASAL F 00933.10 07012013 99999999 1 40799 Unlisted procedure lips M 00000.00 06112012 99999999 1 40800 DRAINAGE OF MOUTH LESION X 00051.33 01012018 99999999 1 40800 DRAINAGE OF MOUTH LESION F 00084.82 07012013 99999999 1 40801 DRAINAGE OF MOUTH LESION F 00161.97 07012013 99999999 1 40801 DRAINAGE OF MOUTH LESION X 00112.35 01012018 99999999 1 40804 REMOVAL FOREIGN BODY MOUTH X 00057.24 01012018 99999999 1 40804 REMOVAL FOREIGN BODY MOUTH F 00093.96 07012013 99999999 1 40805 REMOVAL FOREIGN BODY MOUTH F 00189.77 07012013 99999999 1 40805 REMOVAL FOREIGN BODY MOUTH X 00134.25 01012018 99999999 1 40806 INCISION OF LIP FOLD X 00009.31 01012018 99999999 1 40806 INCISION OF LIP FOLD F 00029.38 07012013 99999999 1 40808 BIOPSY,VESTIBULE OF MOUTH F 00078.47 07012013 99999999 1 40808 BIOPSY,VESTIBULE OF MOUTH X 00044.49 01012018 99999999 1 40810 EXCISION OF LESION OF MUCOSA AND SUBMUCO X 00065.54 01012018 99999999 1 40810 EXCISION OF LESION OF MUCOSA AND SUBMUCO F 00108.62 07012013 99999999 1 40812 EXCISE/REPAIR MOUTH LESION F 00156.80 07012013 99999999 1 40812 EXCISE/REPAIR MOUTH LESION X 00104.68 01012018 99999999 1 40814 EXCISE/REPAIR MOUTH LESION X 00190.92 01012018 99999999 1 40814 EXCISE/REPAIR MOUTH LESION F 00247.18 07012013 99999999 1 40816 EXCISION OF MOUTH LESION F 00260.69 07012013 99999999 1 40816 EXCISION OF MOUTH LESION X 00200.34 01012018 99999999 1 40818 EXCISION OF MUCOSA AS DONOR GRAFT X 00143.11 01012018 99999999 1 40818 EXCISION OF MUCOSA AS DONOR GRAFT F 00192.71 07012013 99999999 1 40819 EXCISION OF FRENUM,LABIAL OR BUCCAL(FREN F 00165.01 07012013 99999999 1 40819 EXCISION OF FRENUM,LABIAL OR BUCCAL(FREN X 00122.10 01012018 99999999 1 40820 DESTRUCTION OF LESION OR SCAR BY PHYSICA X 00057.96 01012018 99999999 1 40820 DESTRUCTION OF LESION OR SCAR BY PHYSICA F 00091.11 07012013 99999999 1 40830 REPAIR MOUTH LACERATION F 00114.08 07012013 99999999 1 40830 REPAIR MOUTH LACERATION X 00069.26 01012018 99999999 1 40831 REPAIR MOUTH LACERATION X 00107.37 01012018 99999999 1 40831 REPAIR MOUTH LACERATION F 00165.15 07012013 99999999 1 40840 RECONSTRUCTION OF MOUTH F 00535.03 07012013 99999999 1 40840 RECONSTRUCTION OF MOUTH X 00403.47 01012018 99999999 1 40842 RECONSTRUCTION OF MOUTH X 00405.09 01012018 99999999 1 40842 RECONSTRUCTION OF MOUTH F 00532.28 07012013 99999999 1 40843 RECONSTRUCTION OF MOUTH F 00740.57 07012013 99999999 1 40843 RECONSTRUCTION OF MOUTH X 00567.26 01012018 99999999 1 40844 RECONSTRUCTION OF MOUTH X 00764.70 01012018 99999999 1 40844 RECONSTRUCTION OF MOUTH F 00958.44 07012013 99999999 1 40845 RECONSTRUCTION OF MOUTH F 01236.07 07012013 99999999 1 40845 RECONSTRUCTION OF MOUTH X 01012.73 01012018 99999999 1 40899 Unlisted px vestibule mouth M 00000.00 06112012 99999999 1 41000 DRAINAGE OF MOUTH LESION X 00064.45 01012018 99999999 1 41000 DRAINAGE OF MOUTH LESION F 00095.04 07012013 99999999 1 41005 DRAINAGE OF MOUTH LESION F 00088.64 07012013 99999999 1 41005 DRAINAGE OF MOUTH LESION X 00049.74 01012018 99999999 1 41006 DRAINAGE OF MOUTH LESION X 00142.05 01012018 99999999 1 41006 DRAINAGE OF MOUTH LESION F 00198.81 07012013 99999999 1 41007 DRAINAGE OF MOUTH LESION F 00219.94 07012013 99999999 1 41007 DRAINAGE OF MOUTH LESION X 00155.16 01012018 99999999 1 41008 DRAINAGE OF MOUTH LESION X 00136.56 01012018 99999999 1 41008 DRAINAGE OF MOUTH LESION F 00196.88 07012013 99999999 1 41009 DRAINAGE OF MOUTH LESION F 00247.83 07012013 99999999 1 41009 DRAINAGE OF MOUTH LESION X 00175.74 01012018 99999999 1 41010 INCISION OF LINGUAL FRENUM (FRENOTOMY) X 00047.43 01012018 99999999 1 41010 INCISION OF LINGUAL FRENUM (FRENOTOMY) F 00090.74 07012013 99999999 1 41015 DRAINAGE OF MOUTH LESION F 00225.89 07012013 99999999 1 41015 DRAINAGE OF MOUTH LESION X 00176.32 01012018 99999999 1 41016 DRAINAGE OF MOUTH LESION X 00216.27 01012018 99999999 1 41016 DRAINAGE OF MOUTH LESION F 00277.18 07012013 99999999 1 41017 DRAINAGE OF MOUTH LESION F 00239.81 07012013 99999999 1 41017 DRAINAGE OF MOUTH LESION X 00185.97 01012018 99999999 1 41018 DRAINAGE OF MOUTH LESION X 00262.88 01012018 99999999 1 41018 DRAINAGE OF MOUTH LESION F 00329.84 07012013 99999999 1 41100 BIOPSY OF TONGUE F 00112.42 07012013 99999999 1 41100 BIOPSY OF TONGUE X 00069.95 01012018 99999999 1 41105 BIOPSY OF TONGUE X 00066.93 01012018 99999999 1 41105 BIOPSY OF TONGUE F 00105.22 07012013 99999999 1 41108 BIOPSY FLOOR OF MOUTH F 00086.56 07012013 99999999 1 41108 BIOPSY FLOOR OF MOUTH X 00051.36 01012018 99999999 1 41110 EXCISION OF TONGUE LESION X 00074.17 01012018 99999999 1 41110 EXCISION OF TONGUE LESION F 00122.65 07012013 99999999 1 41112 EXCISION OF TONGUE LESION F 00197.38 07012013 99999999 1 41112 EXCISION OF TONGUE LESION X 00145.76 01012018 99999999 1 41113 EXCISION OF TONGUE LESION X 00174.31 01012018 99999999 1 41113 EXCISION OF TONGUE LESION F 00233.14 07012013 99999999 1 41114 EXCISION OF TONGUE LESION F 00530.68 07012013 99999999 1 41115 EXCISION OF LINGUAL FRENUM (FRENECTOMY) F 00136.45 07012013 99999999 1 41115 EXCISION OF LINGUAL FRENUM (FRENECTOMY) X 00078.54 01012018 99999999 1 41116 EXCISION,LESION OF FLOOR OF MOUTH X 00121.16 01012018 99999999 1 41116 EXCISION,LESION OF FLOOR OF MOUTH F 00186.82 07012013 99999999 1 41120 GLOSSECTOMY;LESS THAN ONE-HALF TONGUE F 00631.91 07012013 99999999 1 41130 GLOSSECTOMY;HEMIGLOSSECTOMY F 00728.58 07012013 99999999 1 41135 TONGUE AND NECK SURGERY F 01454.84 07012013 99999999 1 41140 GLOSSECTOMY;TOTAL,WITHOUT RADICAL NECK D F 01562.16 07012013 99999999 1 41145 TONGUE REMOVAL NECK SURGERY F 01873.63 07012013 99999999 1 41150 GLOSSCTMY;COMPOSIT PROC,W/O NECK DISEC F 01475.93 07012013 99999999 1 41153 GLOSSCTMY;COMPOSITE PROCEDURE,W/SUPRAH F 01622.65 07012013 99999999 1 41155 GLOSSCTMY;COMPOST PROC RESEC MOUTH FLR F 01900.20 07012013 99999999 1 41250 REPAIR TONGUE LACERATION F 00130.29 07012013 99999999 1 41250 REPAIR TONGUE LACERATION X 00073.21 01012018 99999999 1 41251 REPAIR TONGUE LACERATION X 00096.24 01012018 99999999 1 41251 REPAIR TONGUE LACERATION F 00157.69 07012013 99999999 1 41252 REPAIR TONGUE LACERATION F 00202.35 07012013 99999999 1 41252 REPAIR TONGUE LACERATION X 00132.47 01012018 99999999 1 41510 SUTURE TONGUE TO LIP FOR MICROGNATHIA(DO F 00243.23 07012013 99999999 1 41520 FRENOPLASTY (SURG REVISION OF FRENUM) F 00197.38 07012013 99999999 1 41520 FRENOPLASTY (SURG REVISION OF FRENUM) X 00136.35 01012018 99999999 1 41599 Unlisted px tongue flr mouth M 00000.00 06112012 99999999 1 41800 DRAINAGE ABSCESS,CYST,HEMATOMA X 00043.84 01012018 99999999 1 41800 DRAINAGE ABSCESS,CYST,HEMATOMA F 00084.43 07012013 99999999 1 41805 REMOVAL FOREIGN BODY GUM F 00089.34 07012013 99999999 1 41805 REMOVAL FOREIGN BODY GUM X 00058.24 01012018 99999999 1 41806 REMOVE EMBEDDED FB;DENTAL BONE STRCTUR X 00116.44 01012018 99999999 1 41806 REMOVE EMBEDDED FB;DENTAL BONE STRCTUR F 00168.85 07012013 99999999 1 41820 GINGIVECTMY, EXCISION GINGIVA, EA QUAD F 00158.69 07012013 99999999 1 41821 OPERCULECTOMY,EXCISION PERICORONAL TISSU F 00095.22 07012013 99999999 1 41822 EXCISION FIBROUS TUBEROSITIES F 00183.15 07012013 99999999 1 41822 EXCISION FIBROUS TUBEROSITIES X 00107.41 01012018 99999999 1 41823 EXCISION OSSEOUS TUBEROSITIES X 00174.66 01012018 99999999 1 41823 EXCISION OSSEOUS TUBEROSITIES F 00241.71 07012013 99999999 1 41825 EXCISION OF GUM LESION F 00110.93 07012013 99999999 1 41825 EXCISION OF GUM LESION X 00062.51 01012018 99999999 1 41826 EXCISION OF GUM LESION X 00108.05 01012018 99999999 1 41826 EXCISION OF GUM LESION F 00163.75 07012013 99999999 1 41827 EXCISION OF GUM LESION F 00249.50 07012013 99999999 1 41827 EXCISION OF GUM LESION X 00170.45 01012018 99999999 1 41828 EXCISION OF HYPERPLASTIC ALVEOLAR MUCOSA X 00154.22 01012018 99999999 1 41828 EXCISION OF HYPERPLASTIC ALVEOLAR MUCOSA F 00235.36 07012013 99999999 1 41830 ALVEOLECTOMY,INCLUDING CURETTAGE OF OSTE F 00239.46 07012013 99999999 1 41830 ALVEOLECTOMY,INCLUDING CURETTAGE OF OSTE X 00164.82 01012018 99999999 1 41850 TREATMENT OF GUM LESION F 00063.47 07012013 99999999 1 41870 GUM GRAFT F 00111.07 07012013 99999999 1 41872 GINGIVOPLASTY, EACH QUADRANT F 00193.12 07012013 99999999 1 41872 GINGIVOPLASTY, EACH QUADRANT X 00133.07 01012018 99999999 1 41874 ALVEOPLASTY, EACH QUADRANT F 00220.55 05012020 99999999 1 41874 ALVEOPLASTY, EACH QUADRANT X 00144.99 05012020 99999999 1 41899 Unlisted px dentalvlr strux M 00000.00 06112012 99999999 1 42000 DRAINAGE MOUTH ROOF LESION X 00060.17 01012018 99999999 1 42000 DRAINAGE MOUTH ROOF LESION F 00091.60 07012013 99999999 1 42100 BIOPSY OF PALATE,UVULA F 00096.71 07012013 99999999 1 42100 BIOPSY OF PALATE,UVULA X 00069.31 01012018 99999999 1 42104 EXCISION LESION MOUTH ROOF X 00079.12 01012018 99999999 1 42104 EXCISION LESION MOUTH ROOF F 00125.01 07012013 99999999 1 42106 EXCISION LESION MOUTH ROOF F 00158.03 07012013 99999999 1 42106 EXCISION LESION MOUTH ROOF X 00100.79 01012018 99999999 1 42107 EXCISION LESION MOUTH ROOF X 00232.24 01012018 99999999 1 42107 EXCISION LESION MOUTH ROOF F 00316.89 07012013 99999999 1 42120 RESECTION PALATE OR EXTENSIVE RESECTION F 00443.96 07012013 99999999 1 42140 EXCISION OF UVULA F 00134.54 07012013 99999999 1 42140 EXCISION OF UVULA X 00080.35 01012018 99999999 1 42145 REPAIR PALATE PHARYNX/UVULA F 00574.20 07012013 99999999 1 42160 TREATMENT MOUTH ROOF LESION F 00136.52 07012013 99999999 1 42160 TREATMENT MOUTH ROOF LESION X 00084.83 01012018 99999999 1 42180 REPAIR PALATE X 00127.08 01012018 99999999 1 42180 REPAIR PALATE F 00172.45 07012013 99999999 1 42182 REPAIR PALATE F 00251.94 07012013 99999999 1 42182 REPAIR PALATE X 00197.21 01012018 99999999 1 42200 RECONSTRUCT CLEFT PALATE F 00735.77 07012013 99999999 1 42205 RECONSTRUCT CLEFT PALATE F 00668.01 07012013 99999999 1 42210 RECONSTRUCT CLEFT PALATE F 00913.06 07012013 99999999 1 42215 RECONSTRUCT CLEFT PALATE F 00594.21 07012013 99999999 1 42220 RECONSTRUCT CLEFT PALATE F 00455.62 07012013 99999999 1 42225 RECONSTRUCT CLEFT PALATE F 00623.69 07012013 99999999 1 42226 LENGTHENING OF PALATE F 00658.82 07012013 99999999 1 42227 LENGTHENING OF PALATE F 00592.74 07012013 99999999 1 42235 REPAIR PALATE F 00490.90 07012013 99999999 1 42260 REPAIR NOSE TO LIP FISTULA F 00550.08 07012013 99999999 1 42260 REPAIR NOSE TO LIP FISTULA X 00436.49 01012018 99999999 1 42281 INSERT PIN-RETAINED PALATAL PROSTHESIS F 00209.25 03012024 99999999 1 42281 INSERT PIN-RETAINED PALATAL PROSTHESIS X 00151.03 03012024 99999999 1 42299 Unlisted px palate uvula M 00000.00 06112012 99999999 1 42300 DRAINAGE OF SALIVARY GLAND X 00091.42 01012018 99999999 1 42300 DRAINAGE OF SALIVARY GLAND F 00127.89 07012013 99999999 1 42305 DRAINAGE OF SALIVARY GLAND F 00349.73 07012013 99999999 1 42310 DRAINAGE OF SALIVARY GLAND F 00112.22 07012013 99999999 1 42310 DRAINAGE OF SALIVARY GLAND X 00083.82 01012018 99999999 1 42320 DRAINAGE OF SALIVARY GLAND X 00110.97 01012018 99999999 1 42320 DRAINAGE OF SALIVARY GLAND F 00161.53 07012013 99999999 1 42330 REMOVAL OF SALIVARY STONE F 00143.05 07012013 99999999 1 42330 REMOVAL OF SALIVARY STONE X 00099.19 01012018 99999999 1 42335 REMOVAL OF SALIVARY STONE X 00149.69 01012018 99999999 1 42335 REMOVAL OF SALIVARY STONE F 00222.83 07012013 99999999 1 42340 REMOVAL OF SALIVARY STONE F 00319.33 07012013 99999999 1 42340 REMOVAL OF SALIVARY STONE X 00225.67 01012018 99999999 1 42400 BIOPSY OF SALIVARY GLAND X 00039.76 01012018 99999999 1 42400 BIOPSY OF SALIVARY GLAND F 00077.71 07012013 99999999 1 42405 BIOPSY OF SALIVARY GLAND F 00200.94 07012013 99999999 1 42405 BIOPSY OF SALIVARY GLAND X 00148.84 01012018 99999999 1 42408 EXCISION SUBLINGUAL SALIVARY CYST(RANULA X 00203.33 01012018 99999999 1 42408 EXCISION SUBLINGUAL SALIVARY CYST(RANULA F 00292.87 07012013 99999999 1 42409 DRAINAGE OF SALIVARY CYST F 00206.21 07012013 99999999 1 42409 DRAINAGE OF SALIVARY CYST X 00133.95 01012018 99999999 1 42410 EXCISE PAROTID GLAND/LESION F 00580.32 07012013 99999999 1 42415 EXCISE PAROTID GLAND/LESION F 01061.33 07012013 99999999 1 42420 EXCISE PAROTID GLAND/LESION F 01227.74 07012013 99999999 1 42425 EXCISE PAROTID GLAND/LESION F 00852.72 07012013 99999999 1 42426 EXCISE PAROTID GLAND/LESION F 01460.50 07012013 99999999 1 42440 EXCISE SUBMAXILLARY GLAND F 00491.47 07012013 99999999 1 42450 EXCISE SUBLINGUAL GLAND F 00306.65 07012013 99999999 1 42450 EXCISE SUBLINGUAL GLAND X 00236.66 01012018 99999999 1 42500 REPAIR SALIVARY DUCT X 00243.01 01012018 99999999 1 42500 REPAIR SALIVARY DUCT F 00315.50 07012013 99999999 1 42505 REPAIR SALIVARY DUCT F 00433.58 07012013 99999999 1 42505 REPAIR SALIVARY DUCT X 00345.03 01012018 99999999 1 42507 PAROTID DUCT DIVERSION F 00405.69 07012013 99999999 1 42508 PAROTID DUCT DIVERSION,BILATERAL;W/EXCIS F 00596.40 07012013 99999999 1 42509 PAROTID DUCT DIVERSION F 00713.18 07012013 99999999 1 42510 PAROTID DUCT DIVERSION F 00550.56 07012013 99999999 1 42550 INJECTION FOR SALIVARY X-RAY F 00236.47 07012013 99999999 1 42550 INJECTION FOR SALIVARY X-RAY X 00109.33 01012018 99999999 1 42600 CLOSURE OF SALIVARY FISTULA X 00244.64 01012018 99999999 1 42600 CLOSURE OF SALIVARY FISTULA F 00344.97 07012013 99999999 1 42650 DILATION OF SALIVARY DUCT F 00051.90 07012013 99999999 1 42650 DILATION OF SALIVARY DUCT X 00035.38 01012018 99999999 1 42660 DILATION OF SALIVARY DUCT X 00046.65 01012018 99999999 1 42660 DILATION OF SALIVARY DUCT F 00069.37 07012013 99999999 1 42665 LIGATION OF SALIVARY DUCT F 00184.10 07012013 99999999 1 42665 LIGATION OF SALIVARY DUCT X 00118.25 01012018 99999999 1 42699 Unlisted px salivry glnd/dux M 00000.00 06112012 99999999 1 42700 I&D ABSCESS PERITONSILLAR X 00082.69 01012018 99999999 1 42700 I&D ABSCESS PERITONSILLAR F 00118.01 07012013 99999999 1 42720 I&D ABSC PHRNGL NTRAORL APPR F 00312.46 07012013 99999999 1 42720 I&D ABSC PHRNGL NTRAORL APPR X 00263.62 01012018 99999999 1 42725 I&D ABSC PHRNGL XTRNL APPR F 00618.76 07012013 99999999 1 42800 BIOPSY;OROPHARYNX F 00104.87 07012013 99999999 1 42800 BIOPSY;OROPHARYNX X 00072.51 01012018 99999999 1 42804 BIOPSY OF UPPER NOSE/THROAT X 00059.31 01012018 99999999 1 42804 BIOPSY OF UPPER NOSE/THROAT F 00104.54 07012013 99999999 1 42806 BIOPSY OF UPPER NOSE/THROAT F 00128.80 07012013 99999999 1 42806 BIOPSY OF UPPER NOSE/THROAT X 00075.93 01012018 99999999 1 42808 EXCISE PHARYNX LESION X 00135.14 01012018 99999999 1 42808 EXCISE PHARYNX LESION F 00193.21 07012013 99999999 1 42809 REMOVE PHARYNX FOREIGN BODY F 00128.20 07012013 99999999 1 42809 REMOVE PHARYNX FOREIGN BODY X 00075.59 01012018 99999999 1 42810 EXCISION OF NECK CYST X 00187.94 01012018 99999999 1 42810 EXCISION OF NECK CYST F 00258.42 07012013 99999999 1 42815 EXCISION OF NECK CYST F 00510.11 07012013 99999999 1 42842 EXTENSIVE SURGERY OF THROAT F 00567.10 07012013 99999999 1 42844 EXTENSIVE SURGERY OF THROAT F 00912.86 07012013 99999999 1 42845 EXTENSIVE SURGERY OF THROAT F 01524.39 07012013 99999999 1 42890 LIMITED PHARYNGECTOMY F 00814.91 07012013 99999999 1 42892 REVISION OF PHARYNGEAL WALLS F 00983.28 07012013 99999999 1 42894 REVISION OF PHARYNGEAL WALLS F 01421.02 07012013 99999999 1 42900 REPAIR THROAT WOUND F 00333.81 07012013 99999999 1 42950 RECONSTRUCTION OF THROAT F 00577.20 07012013 99999999 1 42960 CONTROL THROAT BLEEDING F 00138.67 07012013 99999999 1 42961 CONTROL OROPHARYNGEAL HEMORRHAGE;COMPLIC F 00320.13 07012013 99999999 1 42962 CONTROL THROAT BLEEDING F 00467.92 07012013 99999999 1 42970 CONTROL NOSE/THROAT BLEEDING F 00278.56 07012013 99999999 1 42999 Unlisted px phrnx adnd/tnsl M 00000.00 06112012 99999999 1 61575 SKULL BASE/BRAINSTEM SURGERY F 02300.21 07012013 99999999 1 61576 SKULL BASE/BRAINSTEM SURGERY F 03085.45 07012013 99999999 1 61580 CRANIOFACIAL APPROACH SKULL F 01850.43 07012013 99999999 1 61581 CRANIOFACIAL APPROACH SKULL F 02085.58 07012013 99999999 1 61584 ORBITOCRANIAL APPROACH/SKULL F 02167.74 07012013 99999999 1 61586 RESECT NASOPHARYNX SKULL F 01619.26 07012013 99999999 1 61590 INFRATEMPORAL APPROACH/SKULL F 02555.38 07012013 99999999 1 61592 ORBITOCRANIAL APPROACH/SKULL F 02486.51 07012013 99999999 1 64400 NJX AA&/STRD TRIGEMINAL NRV F 00085.33 10012014 99999999 1 64400 NJX AA&/STRD TRIGEMINAL NRV X 00045.49 01012018 99999999 1 64600 INJECTION TREATMENT OF NERVE X 00114.67 01012018 99999999 1 64600 INJECTION TREATMENT OF NERVE F 00211.43 07012013 99999999 1 64612 DESTROY NERVE FACE MUSCLE F 00145.83 07012013 99999999 1 64612 DESTROY NERVE FACE MUSCLE X 00125.42 01012018 99999999 1 64716 NEUROLYSIS AND/OR TRANSPOSITION; CRANIAL F 00405.47 07012013 99999999 1 64722 DECOMPRESSION UNSPEC NERVE F 00318.91 07012013 99999999 1 64736 INCISION OF CHIN NERVE F 00300.86 07012013 99999999 1 64738 INCISION OF JAW NERVE F 00367.87 07012013 99999999 1 64740 INCISION OF TONGUE NERVE F 00358.98 07012013 99999999 1 67900 REPAIR OF BROW PTOSIS F 00611.91 06012022 99999999 1 67900 REPAIR OF BROW PTOSIS X 00459.51 06012022 99999999 1 67914 REPAIR EYELID DEFECT F 00375.05 07012013 99999999 1 67914 REPAIR EYELID DEFECT X 00255.73 01012018 99999999 1 67915 REPAIR EYELID DEFECT X 00189.93 01012018 99999999 1 67915 REPAIR EYELID DEFECT F 00287.30 07012013 99999999 1 67916 REPAIR OF ECTROPION, BLEPHAROPLASTY. EXC F 00519.79 07012013 99999999 1 67916 REPAIR OF ECTROPION, BLEPHAROPLASTY. EXC X 00370.18 01012018 99999999 1 67917 REPAIR OF ECTROPION, BLEPHAROPLASTY EXTE X 00363.20 01012018 99999999 1 67917 REPAIR OF ECTROPION, BLEPHAROPLASTY EXTE F 00489.17 07012013 99999999 1 67921 REPAIR OF ENTROPION, SUTURE F 00356.60 07012013 99999999 1 67921 REPAIR OF ENTROPION, SUTURE X 00235.12 01012018 99999999 1 67922 REPAIR EYELID DEFECT X 00186.45 01012018 99999999 1 67922 REPAIR EYELID DEFECT F 00280.34 07012013 99999999 1 67923 REPAIR EYELID DEFECT F 00553.73 07012013 99999999 1 67923 REPAIR EYELID DEFECT X 00394.40 01012018 99999999 1 67924 REPAIR EYELID DEFECT X 00332.82 01012018 99999999 1 67924 REPAIR EYELID DEFECT F 00468.52 07012013 99999999 1 67930 REPAIR EYELID WOUND F 00325.52 07012013 99999999 1 67930 REPAIR EYELID WOUND X 00210.18 01012018 99999999 1 67935 SUTURE RECENT WOUND EYELID, DIRECT CLOSU X 00380.72 01012018 99999999 1 67935 SUTURE RECENT WOUND EYELID, DIRECT CLOSU F 00523.43 07012013 99999999 1 67950 REVISION OF EYELID F 00551.71 06012022 99999999 1 67950 REVISION OF EYELID X 00419.79 06012022 99999999 1 67961 REVISION OF EYELID F 00442.61 07012013 99999999 1 67961 REVISION OF EYELID X 00342.23 01012018 99999999 1 70100 X-RAY EXAM OF JAW <4VIEWS F 00027.36 07012013 99999999 1 70100 X-RAY EXAM OF JAW <4VIEWS H 00017.99 TC 07012013 99999999 1 70100 X-RAY EXAM OF JAW <4VIEWS G 00009.34 26 07012013 99999999 1 70110 X-RAY EXAM OF JAW 4/> VIEWS G 00012.53 26 07012013 99999999 1 70110 X-RAY EXAM OF JAW 4/> VIEWS H 00021.55 TC 07012013 99999999 1 70110 X-RAY EXAM OF JAW 4/> VIEWS F 00034.07 07012013 99999999 1 70120 X-RAY EXAM OF MASTOIDS F 00030.89 07012013 99999999 1 70120 X-RAY EXAM OF MASTOIDS H 00021.55 TC 07012013 99999999 1 70120 X-RAY EXAM OF MASTOIDS G 00009.34 26 07012013 99999999 1 70130 X-RAY EXAM OF MASTOIDS G 00016.74 26 07012013 99999999 1 70130 X-RAY EXAM OF MASTOIDS H 00027.41 TC 07012013 99999999 1 70130 X-RAY EXAM OF MASTOIDS F 00044.15 07012013 99999999 1 70140 X-RAY EXAM OF FACIAL BONES F 00031.25 07012013 99999999 1 70140 X-RAY EXAM OF FACIAL BONES H 00021.55 TC 07012013 99999999 1 70140 X-RAY EXAM OF FACIAL BONES G 00009.71 26 07012013 99999999 1 70150 X-RAY EXAM OF FACIAL BONES G 00012.88 26 07012013 99999999 1 70150 X-RAY EXAM OF FACIAL BONES H 00027.41 TC 07012013 99999999 1 70150 X-RAY EXAM OF FACIAL BONES F 00040.30 07012013 99999999 1 70160 X-RAY EXAM OF NASAL BONES F 00026.66 07012013 99999999 1 70160 X-RAY EXAM OF NASAL BONES H 00017.99 TC 07012013 99999999 1 70160 X-RAY EXAM OF NASAL BONES G 00008.66 26 07012013 99999999 1 70190 X-RAY EXAM OF EYE SOCKETS G 00010.76 26 07012013 99999999 1 70190 X-RAY EXAM OF EYE SOCKETS H 00021.55 TC 07012013 99999999 1 70190 X-RAY EXAM OF EYE SOCKETS F 00032.30 07012013 99999999 1 70200 X-RAY EXAM OF EYE SOCKETS F 00041.34 07012013 99999999 1 70200 X-RAY EXAM OF EYE SOCKETS H 00027.41 TC 07012013 99999999 1 70200 X-RAY EXAM OF EYE SOCKETS G 00013.93 26 07012013 99999999 1 70250 X-RAY EXAM OF SKULL G 00012.16 26 07012013 99999999 1 70250 X-RAY EXAM OF SKULL H 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