AS OF 10/28/19

D0160 – Detailed and extensive oral evaluation – problem focused – $350.00

D7880 – Occlusal orthotic device, by report – splints provided for treatment of TMJ – $2995.00 + 2 splint adjustments

D7881 – Occlusal orthotic device adjustment – $295.00

D7899 – Unspecified TMD therapy, by report – used for procedure not adequately described by a code – $295.00 – $2995.00

D8010 – Limited orthodontic treatment of the primary dentition – $600.00

D8020 – Limited orthodontic treatment of the transitional dentition – $1800.00

D8030 – Limited orthodontic treatment of the adolescent dentition – $3800.00

D8040 – Limited orthodontic treatment of the adult dentition – $4300.00

D8060 – Interceptive orthodontic treatment of the transitional dentition – 1800.00 – $2770.00

D8070 – Comprehensive orthodontic treatment of the transitional dentition – $2445.00 – $2945.00

D8080 – Comprehensive orthodontic treatment of the adolescent dentition – $5145.00 – $5895.00

D8090 – Comprehensive orthodontic treatment of the adult dentition – $5745.00 – $6745.00

D8210 – Removable appliance therapy – $180.00 – $700.00

D8220 – Fixed appliance therapy – $600.00 – $1800.00

D8680 – Orthodontic retention (removal of appliances, construction/placement of retainer) – $750.00 –  $2000.00

D8681 – Removable orthodontic retainer adjustment – $150.00 – $325.00

D8692 – Replacement of lost or broken retainer – $180.00 – $460.00

D8694 – Repair of fixed retainers, includes reattachment – $75.00 – $200.00

D9951 – Occlusal adjustment – limited – equilibration – $350.00 – $650.00 per adjustment

D9952 – Occlusal adjustment – complete – equilibration – study models – $350.00 – $650.00 per adjustment