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Dental in Nature Oral Surgery CDT D3410 D3421 D3425 D3426 D3430 D3450 D3460 D3470 D3920 D4210 PROCEDURE DESCRIPTION apicoectomy/periradicular surgery - anterior apicoectomy/periradicular surgery ­ bicuspid (first root) apicoectomy/periradicular surgery ­ molar (first root) apicoectomy/periradicular surgery (each additional root) retrograde filling ­ per tooth root amputation - per root endodontic endosseous implant intentional reimplantation (including necessary splinting) hemisection (including any root removal), not including root canal therapy gingivectomy or gingivoplasty - four or more contiguous teeth or bounded teeth spaces per quadrant gingivectomy or gingivoplasty - one to three teeth, per quadrant gingival curettage, surgical ­ per quadrant, by report (Deleted 1/01/03) gingival flap procedure, including root planing - four or more contiguous teeth or bounded teeth spaces per quadrant gingival flap procedure, including root planing - one to three teeth, per quadrant apically positioned flap osseous surgery (including flap entry and closure) four or more contiguous teeth or bounded teeth spaces per quadrant osseous surgery (including flap entry and closure) one to three teeth, per quadrant bone replacement graft first in quadrant bone replacement graft each additional site in quadrant biologic materials to aid in soft and osseous tissue regeneration guided tissue regeneration - resorbable barrier, per site guided tissue regeneration - nonresorbable barrier, per site (includes membrane removal) CPT Code No Code No Code No Code No Code No Code No Code No Code No Code No Code 41820 41872 Gingivectomy, excision gingival, each quadrant Gingivoplasty, each quadrant PROCEDURE DESCRIPTION

D4211 D4220 D4240

41820 41872 No Code No Code

Gingivectomy, excision gingival, each quadrant Gingivoplasty, each quadrant

D4241 D4245 D4260

No Code No Code 41874

Alveoloplasty, each quadrant (specify)

D4261

41874

Alveoloplasty, each quadrant

D4263 D4264 D4265 D4266 D4267

No Code No Code No Code No Code No Code

Dental in Nature Oral Surgery

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CDT D4268 D4270 D4271 D4273 D4274

D4275 D4276 D7210

D7220 D7230 D7240 D7241

D7250 D7260 D7261 D7272

PROCEDURE DESCRIPTION surgical revision procedure, per tooth pedicle soft tissue graft procedure free soft tissue graft procedure (including donor site surgery) subepithelial connective tissue graft procedures distal or proximal wedge procedure (when not performed in conjunction with surgical procedures in the same anatomical area) soft tissue allograft combined connective tissue and double pedicle graft surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth. removal of impacted tooth soft tissue removal of impacted tooth partially bony removal of impacted tooth completely bony removal of impacted tooth completely bony, with unusual surgical complications. surgical removal of residual tooth roots (cutting procedure) oroantral fistula closure primary closure of a sinus perforation tooth transplantation (includes reimplantation from one site to another and splinting and/or stabilization) surgical access of an unerupted tooth surgical exposure of impacted or unerupted tooth to aid eruption mobilization of erupted or malpositioned tooth to aid eruption Placement of device to facilitate eruption of impacted tooth surgical repositioning of teeth transseptal fiberotomy/supra crestal fiberotomy, by report alveoloplasty in conjunction with extractions - per quadrant

CPT Code 41874 41870 41870 41870 41821

PROCEDURE DESCRIPTION Alveoloplasty, each quadrant (specify) Periodontal mucosal grafting Periodontal mucosal grafting Periodontal mucosal grafting Operculectomy, excision of pericoronal tissues

41870 41870 No Code

Periodontal mucosal grafting Periodontal mucosal grafting

No Code No Code No Code No Code

No Code 30580 30580 No Code Repair fistula, oromaxillary (combine with 31030 if antroto included) Repair fistula, oromaxillary (combine with 31030 if antroto included)

D7280 D7281 (code deleted for 2005) D7282 D7283 D7290 D7291 D7310

No Code No Code

No Code No Code No Code 41874 Alveoloplasty, each quadrant

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CDT D7311

PROCEDURE DESCRIPTION alveoloplasty in conjunction with extractions ­ one to three teeth or tooth spaces, per quadrant alveoloplasty not in conjunction with extractions - per quadrant alveoloplasty not in conjunction with extractions ­ one to three teeth or tooth spaces, per quadrant vestibuloplasty ­ ridge extension (secondary epithelialization) vestibuloplasty - ridge extension (including soft tissue grafts, muscle reattachment, revision of soft tissue attachment and management of hypertrophied and hyperplastic tissue) removal of lateral exostosis (maxilla and mandible) removal of torus palatinus removal of torus mandibularis surgical reduction of osseous tuberosity bone replacement graft for ridge preservation ­ per site Frenulectomy (frenectomy or frenotomy) - separate procedure

CPT Code 41874 - 52

PROCEDURE DESCRIPTION

D7320 D7321

41874

Alveoloplasty, each quadrant

D7340

40840 40842 40843 40844 40845

D7350

Vestibuloplasty; anterior Vestibuloplasty; posterior, Vestibuloplasty; unilateral/posterior, Vestibuloplasty; bilateral/entire arch Vestibuloplasty, complex (including ridge extension, muscle repositioning)

D7471 D7472 D7473 D7485 D7953

41823 21032 21031 41823 No Code

Excision of osseous tuberosities, dentoalveolar structure Excision of maxillary torus palatinus Excision of torus mandibular Excision of osseous tuberosities, dentoalveolar structure

D7960

40806, 40819, 41010, 41115,

Incision of labial frenum (frenotomy) Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy) Incision of lingual frenum (frenotomy) Excision of lingual frenum (frenectomy) Frenoplasty (surgical revision of frenum, e.g., with Z-plasty) Excision of hyperplastic alveolar mucosa, each quadrant Operculectomy, excision of pericoronal tissues Excision of fibrous tuberosities, dentoalveolar structures

D7963 D7970 D7971 D7972

frenuloplasty excision of hyperplastic tissue - per arch excision of pericoronal gingiva surgical reduction of fibrous tuberosity

41520 41828 41821 41822

The global service package for a surgery ("global surgical package") includes the surgery itself and all postoperative care visits rendered during the global surgical period. Beginning on August 11, 2006, we will assign a global surgical period of 30 days for Dental in Nature oral surgery procedures when services are considered by the Aetna Medical plan. As a result, any post operative care including exams, suture removal, and follow up visits will be considered inclusive to the global surgical package.

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