HAMLY MEDICAL CENTER
DESCRIPTION CPT PROCEDURE
Dental Services
1 Consultation –First Visit Only
2 Radiographs-Intra Oral Periapical
3 Composite Fillings with Light Cure –simple –One surface
4 Pulpectomy (Root Canal Treatment)-Anteriors
5 Pulpectomy-(Root Canal Treatment) –Posteriors
6 Apicoectomy-Peri apical Curettage/surgery
7 Dental Extraction- Normal/Routine
8 Dental Extraction Complicated/Surgical
Surgical Removal of complicated Impacted Wisdom
9 Tooth
Open Surgical Extraction of Complicated Impaction Tooth
10
11 Ceramo-Metal (Porcelain fused to non precious Metal) Crown
12 Bitewing Radiograph
13 Panoramic Radiograph – OPG
14 Cephalometric Radiograph
15 Anti decay- Fluoride Application Treatment
16 Fissure Sealant Application Per Tooth
17 Calcium Hydroxide-Pulp Capping Direct/Indirect
18 Temporary Filling Deciduous Tooth
18 Temporary Filling Permanent Tooth
19 Silver Amalgam Filling-One Surface
20 Silver Amalgam Filling 2-5 Surfaces
21 Composite Fillings 2-5 Surfaces
22 Glass Ionomer Fillings- One surface
23 Glass Ionomer Fillings 2-5 Surfaces
Pulpotomy with Restoration
24
25 Oral Prophylaxis (Scaling/Polishing)
26 Sub Gingival deep scaling
27 Desensitisation with desensitizing agent.
28 Gingivectomy/Flap surgery -per quadrant
29 Operculectomy
30 Incision and Curettage –Drainage of Abscess .
Orthodontic Treatment with Braces Fixed Appliance-
31 Regular
32 Orthodontic Treatment with Braces –F.A Complicated
33 Ortrhodontic Retainer –Single Jaw
34 Dry Socket Treatment
35 Selective Grinding/aligning
36 Teeth Whitening/Bleaching-office bleaching with ZoomII
Home Bleaching Kit with Custom Trays 1000/=
37
38 Zirconium Crown
39 Ceramo-Metal (Porcelain fused to non precious Metal) Crown
40 Empress/Emax Metal free Ceramic Crowns
*Commonly Used Procedures with Enaya Patients (Initial red serial numbers shown)
please use corresponding standard
codes avaliable in eclaimlink.ae
corresponding standard cpt 4 / cdt
NET GROSS (for dental only)
Gross Net Amount Dhs.
100
150 D0150
100 50 D0220
200 100 D2330
500 300 D3310
600 400 D3330
500
750 D3410
100
150 D7140
200
300 D7230
300
500 D7240
650
1000 D7241
600 400 D6720
100 50 D0270
200 120 D0330
200 130 D0340
150 100 D1204
100
150 D1351
100
150 D3110
150 100 D2999
150 100 D2999
150 100 D2140
200 130 D2150
250 150 D2331
150 100 D2999
200 130 D2999
130
200 D3220
130
200 D1110
200
300 D4341
100
150 D9910
325
500 D4240
200
350 D4268
200 130 D7510
3900
6000 D8080
10000 6500 D8090
300
500 D8210
100
200 D4381
300 200 D9971
1500 975 D9972
650
1000 D9973
2000 1300 D6740
1000 650 D6751
1200 750 D6783
al numbers shown)
please use corresponding standard full description
andard available in eclaimlink.ae
.ae
PLEASE NOTE THAT IN DENTAL (CDT CODES), USE
NOMENCLATURE ONLY IF THERE IS NO
DESCRIPTION AVAILABLE.
corresponding standard full description
Used by a general dentist and/or a specialist when evaluating a patient
comprehensively. This applies to new patients; established patients who have had
a significant change in health conditions or other unusual circumstances, by
report, or established patients who have been absent from active treatment for
three or more years. It is a thorough evaluation and recording of the extraoral and
intraoral hard and soft tissues. It may require interpretation of information
acquired through additional diagnostic procedures. Additional diagnostic
procedures should be reported separately. This includes an evaluation for oral
cancer where indicated, the evaluation and recording of the patient’s dental and
medical history and a general health assessment. It may include the evaluation
and recording of dental caries, missing or unerupted teeth, restorations, existing
prostheses, occlusal relationships, periodontal conditions (including periodontal
screening and/or charting), hard and soft tissue anomalies, etc.
Radiographs - Intraoral - periapical first film
resin-based composite - one surface
Endodontic therapy, anterior tooth (excluding final restoration)
Endodontic therapy, posterior tooth (excluding final restoration)
For surgery on root of anterior tooth. Does not include placement of retrograde
filling material.
Includes routine removal of tooth structure, minor smoothing of socket bone, and
closure, as necessary.
Part of crown covered by bone; requires mucoperiosteal flap elevation and bone
removal.
Most or all of crown covered by bone; requires mucoperiosteal flap elevation and
bone removal.
Most or all of crown covered by bone; unusually difficult or complicated due to
factors such as nerve dissection required, separate closure of maxillary sinus
required or aberrant tooth position.
Crown - resin with high noble metal
Bitewing - single film
Panoramic film
Cephalometric film
Topical Application of flouride
Mechanically and/or chemically prepared enamel surface sealed to prevent decay.
Procedure in which the exposed pulp is covered with a dressing or cement that
protects the pulp and promotes healing and repair.
Unspecified restorative procedure, by report
Unspecified restorative procedure, by report
Amalgam - one surface, primary or permanent
Amalgam - two surfaces, primary or permanent
resin-based composite - two surfaces
Unspecified restorative procedure, by report
Unspecified restorative procedure, by report
Therapeutic pulpotomy
Removal of plaque, calculus and stains from the tooth structures in the permanent
and transitional dentition. It is intended to control local irritational factors.
This procedure involves instrumentation of the crown and root surfaces of the
teeth to remove plaque and calculus from these surfaces. It is indicated for
patients with periodontal disease and is therapeutic, not prophylactic, in nature.
Root planing is the definitive procedure designed for the removal of cementum
and dentin that is rough, and/or permeated by calculus or contaminated with
toxins or microorganisms. Some soft tissue removal occurs. This procedure may
be used as a definitive treatment in some stages of periodontal disease and/or as
a part of pre-surgical procedures in others.
Includes in-office treatment for root sensitivity. Typically reported on a "per visit"
basis for application of topical fluoride. This code is not to be used for bases,
liners or adhesives used under restorations.
A soft tissue flap is reflected or resected to allow debridement of the root surface
and the removal of granulation tissue. Osseous recontouring is not accomplished
in conjunction with this procedure. May include open flap curettage, reverse
bevel flap surgery, modified Kirkland flap procedure, and modified Widman
surgery. This procedure is performed in the presence of moderate to deep
probing depths, loss of attachment, need to maintain esthetics, need for increased
access to the root surface and alveolar bone, or to determine the presence of a
cracked tooth, fractured root, or external root resorption. Other procedures may
be required concurrent to D4240 and should be reported separately using their
own unique codes
This procedure is to refine the results of a previously provided surgical procedure.
This may require a surgical procedure to modify the irregular contours of hard or
soft tissue. A mucoperiosteal flap may be elevated to allow access to reshape
alveolar bone. The flaps are replaced or repositioned and sutured.
Involves incision through mucosa, including periodontal origins.
comprehensive orthodontic treatment of the adolescent dentition
comprehensive orthodontic treatment of the adult dentition
Removable indicates patient can remove; includes appliances for thumb sucking
and tongue thrusting.
topical medicament on tooth or localized delivery of antimicrobial agents
via a controlled release vehicle into diseased crevicular tissue, per ttoth,
by report
odontoplasty 1-2 teeth; includes removal of enamel projections
External Bleaching - Office(Per Arch)
External Bleaching - Home (Per tooth)
Crown - Full Porcelain / Full Ceramic or Zirconium made
Crown - porcelain fused to predominantly base non-precious metal
Crown - 3/4 porcelain or full ceramic
