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<br />-- -- ---~---~------~--- <br />------ - <br /> <br />-------p--- <br /> <br />Appendix B <br /> <br />PROCEDURE HOMBBRS <br /> <br />Procedure Humber <br /> <br />Procedure <br /> <br />00100-00999 -- DIAGNOSTIC <br /> <br />Clinical oral examinations <br /> <br />00110 <br />00120 <br />00130 <br /> <br />Radiographs <br /> <br />00210 <br />00220 <br />00230 <br />00240 <br />00250 <br />00260 <br />00270 <br />00272 <br />00273 <br />00274 <br />00330 <br />00340 <br /> <br />Initial oral examination <br />Periodic oral examination <br />Emergency oral examination <br /> <br />Intraoral -- complete series (including bitewings) <br />Intraoral -- periapical -- first film <br />Intraoral -- periapical -- each additional film <br />Intraoral -- occlusal film <br />Extraoral -- first film <br />Extraoral -- each additional film <br />Bitewings -- single film <br />Bitewings -- two films <br />Bitewings -- three films <br />Bitewings -- four films <br />Panoramic film <br />Cephalometric film <br /> <br />Tests and laboratory examinations <br /> <br />00470 <br />00501 <br /> <br />Diagnostic casts <br />Histopathologic examinations <br /> <br />01000-01999 -- PREVENTIVE <br /> <br />Dental prophylaxis <br /> <br />01110 <br />01120 <br /> <br />Prophylaxis -- adult <br />prophylaxis -- child to age 14 <br /> <br />Topical fluoride treatment (office procedure) <br /> <br />01201 <br /> <br />01205 <br /> <br />01203 <br /> <br />---- <br />- - ---- <br /> <br />(including prophylaxis) - <br /> <br />Topical application of fluoride <br />- child to age 14 <br />Topical application of fluoride <br />- adult <br />Topical application of fluoride <br />- child to age 14 <br /> <br />(including prophylaxis) - <br /> <br />(excluding prophylaxis) - <br /> <br />1 <br /> <br />--- <br />----- <br /> <br />-- <br /> <br />-- <br /> <br />--- <br /> <br />---- -------- <br />