Procedure Codes and Definitions

D7210 Surgical Extraction

D7140 Single Tooth Extraction

D7250 Root Removal

D7280 Surgical Exposure

D7283 Exposure with Bracket

41115 Frenectomy Lingual (Lower)

D7963 Frenectomy Labial (Upper)

D3425 Apico Molar

D3410 Apico Anterior

D7230 Partial Bone Impaction

D7240 Full Bone Impaction

D7220 Soft Tissue Impaction

D9220 General Anesthesia (1st 30 minutes)

D9221 General Anesthesia (add’l 15 minutes)

D9230 Nitrous Oxide

99203 Consultation

70355 Panorex x-ray

Deductible: The amount determined by the insurance that needs to be met before the insurance company will pay on any claim.

Co-insurance: The amount the patient is responsible for.

Example: (80/20 plan) 20% is the co-insurance amount.

Co-pay: A set amount determined by the insurance company that the patient is responsible for.

U.C.R.: Usual & Customary Rates (Fee Schedule amount/rates.)

Waiting period: Time period a patient may need to wait before insurance kicks in and starts to cover services.

Coordination of Benefits: When two or more insurances are involved- the second insurance picks up and pays the balance of what the first insurance did not cover (the amount will never exceed 100%)

Birthday Rule: Goes by month born and not by year.

Example 2 parents: Fathers D.O.B. is 10/06/1967 and Mothers D.O.B. is 05/15/1965

Mom’s insurance would be billed 1st since May comes before October.

Primary /Secondary Insurance: Following the birthday rule for children – If the patient has insurance their’s would be primary and the spouse’s insurance would be secondary

Pre-Certification / Pre-Authorization: Placing a call to the insurance company prior to services being rendered to receive a verbal estimate of coverage.

Pre-Determination: Submitting a”fake” claim to the insurance company before services are rendered to determine the actual out of pocket costs for the patient. (process takes 4-6 weeks)