Description - DE Medical Assistance Program

Procedure Code Description Pricing Percent
D0120 PERIODIC ORAL EVALUATION 80
D0140 LIMIT ORAL EVAL PROBLM FOCUS 80
D0145 ORAL EVALUATION, PT < 3YRS 80
D0150 COMPREHENSVE ORAL EVALUATION 80
D0160 EXTENSV ORAL EVAL PROB FOCUS 80
D0170 RE-EVAL,EST PT,PROBLEM FOCUS 80
D0210 INTRAOR COMPLETE FILM SERIES 80
D0220 INTRAORAL PERIAPICAL FIRST F 80
D0230 INTRAORAL PERIAPICAL EA ADD 80
D0240 INTRAORAL OCCLUSAL FILM 80
D0250 EXTRAORAL FIRST FILM 80
D0260 EXTRAORAL EA ADDITIONAL FILM 80
D0270 DENTAL BITEWING SINGLE FILM 80
D0272 DENTAL BITEWINGS TWO FILMS 80
D0273 BITEWINGS - THREE FILMS 80
D0274 DENTAL BITEWINGS FOUR FILMS 80
D0277 VERT BITEWINGS-SEV TO EIGHT 80
D0290 DENTAL FILM SKULL/FACIAL BON 80
D0310 DENTAL SALIOGRAPHY 80
D0320 DENTAL TMJ ARTHROGRAM INCL I 80
D0321 DENTAL OTHER TMJ FILMS 80
D0322 DENTAL TOMOGRAPHIC SURVEY 80
D0330 DENTAL PANORAMIC FILM 80
D0340 DENTAL CEPHALOMETRIC FILM 80
D0360 CONE BEAM CT 80
D0362 CONE BEAM, TWO DIMENSIONAL 80
D0363 CONE BEAM, THREE DIMENSIONAL 80
D0460 PULP VITALITY TEST 80
D0470 DIAGNOSTIC CASTS 80
D0472 GROSS EXAM, PREP & REPORT 80
D0473 MICRO EXAM, PREP & REPORT 80
D0474 MICRO W EXAM OF SURG MARGINS 80
D0480 CYTOPATH SMEAR PREP & REPORT 80
D0502 OTHER ORAL PATHOLOGY PROCEDU 80