MSP Billing Codes

Specialty: Dental Technical Procedures

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Code Description Fee

Appliances - Removable / Retention (Splint)

03825 Appliances, removable, retention (splint) mandibul $316.85
03824 Appliances, removable, retention (splint) maxillar $316.85
03826 Appliances/removable/retention(splint) - palatal $63.36

Cephalometric Radiographs

03804 Cephalometric radiographs pre-treatment post-treat $40.97
03805 Cephalometric radiographs pre-treatment post-treat $67.87
03806 Cephalometric radiographs pre-treatment post-treat $26.91
03807 Cephalometric tracing/interpretation pre-treatment $76.05

Intraoral Radiographs

03841 Occlusal - single film $20.91
03842 Occlusal - two films $30.93
03835 Periapical - five films $39.99

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03834 Periapical - four films $34.03
03831 Periapical - single film $16.00
03836 Periapical - six films $46.00
03833 Periapical - three films $28.03
03832 Periapical - two films $22.05


03803 Panoramic radiographs pre-treatment post-treatment $62.74

Radiographs / Duplications

03820 Casts, diagnostic, mounted using facebow and occlu $301.28
03819 Casts, diagnostic, mounted, one or more sets maybe $82.53
03822 Diagnostic (ghathological wax-up) model surgery tw $152.10
03821 Diagnostic (gnathological wax-up) model surgery on $76.05
03823 Diagnostic (gnathological wax-up) model surgery th $228.14
03817 Diagnostic models, upper and lower $69.43
03818 Duplicate models, upper and lower $38.03
03816 Photographs, each additional $5.45
03815 Photographs, first photograph $16.41
03847 Radiographs/duplications - each additional $4.20
03844 Radiographs/duplications - single film $7.36
03846 Radiographs/duplications - three films $21.88
03845 Radiographs/duplications - two films $14.50

TMJ Radiographs

03830 Tmj radiographs - each additional film over four $26.91
03811 Tmj radiographs, radiographs, tmj one film $40.97
03814 Tmj radiographs, radiographs, tmj, four films $124.21
03813 Tmj radiographs, radiographs, tmj, three films $94.54
03812 Tmj radiographs, radiographs, tmj, two films $67.87
03809 Tmj radiographs, tomography, single view $56.31
03810 Tmj radiographs, tomography, two views $70.56

The information presented on this page is general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBCx or its affiliates.

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