| Fee Code |
|
Description |
D.D.S. Fee |
Specialist Fee |
| T022 |
|
In two segments –
add |
--- |
288.36 |
| T023 |
|
In three or more
segments – add |
--- |
577.63 |
| T024 |
|
In two segments -
add |
--- |
288.36 |
| T025 |
|
In three or more
segments – add |
--- |
577.63 |
| T026 |
|
In two segments -
add |
--- |
288.36 |
| T027 |
|
In three or more
segments – add |
--- |
577.63 |
| T028 |
|
In two segments -
add |
--- |
248.73 |
| T029 |
|
In three or more
segments – add |
--- |
497.53 |
| T030 |
|
With SMR – add |
--- |
199.01 |
| T031 |
|
With
pharyngoplasty – add |
--- |
298.58 |
| T040 |
|
With closure
alveolar fistula – add |
--- |
372.94 |
| T041 |
|
With bone graft –
add |
--- |
236.14 |
| T042 |
|
With closure hard
palate fistula – add |
--- |
497.53 |
| T043 |
|
With bone graft –
add |
--- |
236.14 |
| T121 |
|
Application of
arch bar, and/or splint and/or wiring of dentures – one add |
117.92 |
147.42 |
| T122 |
|
Application of
arch bar(s), and/or splint(s) and/or wiring of dentures – two add |
189.34 |
236.66 |
| T125 |
|
Application of
arch bar(s), and/or splint(s) and/or wiring of dentures – three or more add |
255.22 |
307.90 |
| T126 |
|
Rigid internal
Fixation – add per side per site |
--- |
96.55 |
| T200 |
77330 |
LeFort III
osteotomy |
--- |
1,980.02 |
| T212 |
|
Cranioplasty |
--- |
1,326.25 |
| T213 |
|
Cranial vault
reshaping |
--- |
1,803.70 |
| T214 |
|
Nasal
reconstruction |
--- |
1,697.60 |
| T407 |
75531 |
Partial
mandibulectomy – up to 3 cm |
--- |
615.60 |
| T408 |
75532 |
Partial
mandibulectomy – over 3 cm |
--- |
923.60 |
| T409 |
75540 |
Total
mandibulectomy |
--- |
1,385.20 |
| T423 |
76197 |
Removal of
fixation screw(s) and/or plate(s) – per operative site |
--- |
168.08 |
| T427 |
75551 |
Partial
maxillectomy – up to 3 cm |
--- |
615.60 |
| T428 |
75552 |
partial
maxillectomy – over 3 cm |
--- |
923.60 |
| T429 |
75560 |
Total maxillectomy |
--- |
1,385.20 |
| T532 |
77300 |
In one segment |
--- |
1,270.37 |
| T534 |
|
In one segment |
--- |
1,270.37 |
| T536 |
|
In one segment |
--- |
1,345.97 |
| T538 |
|
In one segment |
--- |
1,482.43 |
| T540 |
77100 |
Subcondylar
osteotomy – closed |
--- |
878.02 |
| T541 |
77120 |
Subcondylar
osteotomy – extraoral |
--- |
1,270.37 |
| T542 |
77130 |
Oblique osteotomy
of ramus – extraoral |
--- |
1,270.37 |
| T543 |
77140 |
Oblique osteotomy
of ramus – intraoral |
--- |
1,270.37 |
| T544 |
77150 |
Body osteotomy or
ostectomy |
--- |
1,270.37 |
| T545 |
77160 |
Coronoidectomy –
unilateral |
--- |
543.12 |
| T546 |
77170 |
Osteotomy of the
condylar neck – unilateral |
--- |
543.12 |