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<br />- ~--~ ~ <br /> <br />---~ <br /> <br />---~ <br /> <br />~~-~-----~~ ~- <br /> <br />04000-04999 -- PERIODONTICS <br /> <br />Surgical services (including usual postoperative services) <br /> <br />0421.0 <br />0421.1. <br />04220 <br /> <br />04240 <br /> <br />04249 <br />04250 <br />04260 <br /> <br />04268 <br /> <br />04270 <br />04271. <br /> <br />Gingivectomy or gingivoplasty -- per quadrant <br />Gingivectomy or gingivoplasty -- single tooth <br />Gingival curettage, surgical -- per quadrant, narrative <br />report required <br />Gingival flap procedure, including root planning -- per <br />quadrant <br />Crown lengthening -- hard and soft tissue, by report <br />Mucogingi val surgery - - per quadrant <br />Osseous surgery (including flap entry, all grafts and <br />closure) -- per quadrant <br />Guided tissue regeneration, includes surgery and re- <br />entry, narrative report required <br />Pedicle soft tissue graft procedure <br />Free soft tissue graft procedure (including donor site) <br /> <br />Adjunctive periodontal services <br /> <br />04341. <br /> <br />Periodontal root planing - per quadrant <br /> <br />Other periodontal services <br /> <br />0491.0 <br /> <br />04920 <br /> <br />Periodontal maintenance procedures following active <br />therapy (periodontal prophylaxis) <br />Unscheduled dressing change (by someone other than <br />treating dentist), by report <br /> <br />05000-05899 -- PROSTHODONTICS (REMOVABLE) <br /> <br />Complete dentures (including routine postdelivery care) <br /> <br />05HO <br />051.20 <br />051.30 <br />051.40 <br /> <br />Complete denture, upper <br />Complete denture, lower <br />Immediate denture, upper <br />Immediate denture, lower <br /> <br />5 <br /> <br />-~ <br /> <br />- - ------- <br /> <br />~- -----~ <br /> <br />---~- - <br />