Most common D4200 code reviews : HbA1c in-office, point-of-service testing - not covered, Non-ionizing diagnostic procedure capable of quantifying, monitoring and recording changes in structure of enamel, dentin and cementum or Accession of tissue, gross examination, preparation and transmission of written report.
Sealant-per tooth Sealants and/or Preventive Resin Restorations are Benefited once per tooth on the occlusal surface of permanent first and second molars for Patients through age fifteen (15). The teeth must be free from caries orrestorations on the occlusal surface. A sealant or preventive resin restoration done on the same date of service and on the same surface as a restoration is considered a component of the restoration, and the fee for the sealant or preventive resin restoration is Disallowed.
Separation of one or more connections between abutments and/or pontics when some portion of a fixed rosthesis is to remain intact D4200 and serviceable following sectioning and extraction or other treatment Includes all recontouring and olishing of retained portions.
In lieu of surgery, the formation of a pathway to achieve an apical seal without surgical intervention ecause of a non-negotiable root canal blocked by foreign bodies,D4200 included but not limited to separated instruments, broken posts or alcification of 50% or more of the roots.
Sealant repair - per tooth - This procedure is disallowed when performed by the same dentist/dental office based on the same time limitation that exists for replacement of a sealant. It is allowed at 50% of D4200 when performed by a different provider or if after the time limitation for the same dentist.
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