Procedure Codes and Definitions

Procedure Codes:
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)