MSP Billing Codes

Specialty: Pediatric Dental Specialists

Code	Description	Fee
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28215	Immediate recovery of a tooth or foreign body	$92.52
28216	Secondary recovery of a tooth or foreign body	$292.19
28217	Closure of an oral antral fistula	$201.95
28000	Emergency consultation in a hospital	$104.53
28001	Emergency consult surcharge-sat,sun,stat 1800-0800	$23.63
28005	Non-emergent consultation	$104.53
28006	In hospital consult-non emergent	$143.37
28008	Hospital visit for medical mgmt of oral disease	$21.44
28012	Call out when dentist called by ha	$250.04
28013	Call-out charges - evening	$59.42
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28014	Call-out charges - night	$83.43
28015	Call-out charges - sat/sun or statutory holidays	$59.42
28023	Continuing care operative surcharges - evening	$409.76
28024	Continuing care operative surcharges - night	$575.41
28025	Cont care operative surcharges - sat/sun or stats	$409.76
28165	Intraosseous implants - placement of first unit	$194.79
28166	Intraosseous implants - each additional placed	$121.76
28168	Intraosseous implants - exposure of first unit	$99.15
28169	Intraosseous implants - each additional exposed	$49.59
28172	Removal of implants - subperiosteal/mandibular	$584.36
28174	Removal of implants - intraosseous, first unit	$97.40
28175	Removal of implants - intraosseous/additional unit	$48.69
28270	Post operative complications	$43.83
28030	Erupted teeth - first tooth per quadrant	$75.42
28031	Erupted teeth - each addition tooth	$49.69
28033	Erupted teeth - surgical removal with flap	$147.44
28034	Erupted teeth-each add. surgical removal with flap	$104.50
28040	Impacted teeth - soft tissue	$147.44
28041	Impacted - teeth - each additional 'soft tissue'	$97.29
28045	Impacted teeth - partial bony	$169.92
28046	Impacted teeth - each additional 'part bony'	$80.35
28050	Impacted teeth - full bony	$237.48
28051	Impacted teeth - each additional 'full bony'	$119.02
28054	Impacted teeth - full bony of extreme difficulty	$253.25
28055	Impacted teeth -each add full bony extreme difficu	$175.31
28058	Impacted teeth - removal of a tooth follicle	$140.44
28059	Impacted teeth - each additional tooth follicle	$112.28
28060	Residual roots - soft tissue first per quadrant	$90.30
28061	Residual roots - each additional soft tissue	$39.96
28063	Residual roots - bone coverage first per quadrant	$170.00
28064	Residual roots - each additional 'bone coverage'	$63.51
28070	Tooth transplantation	$292.19
28071	Tooth transplantation - each additional	$146.08
28073	Surgical uprighting/repositioning	$206.63
28074	Surgical uprighting - each additional per quadrant	$103.43
28076	Surgical uprighting/repositioning/uncovering	$248.45
28077	Surgical uprighting/repos/uncover-each additional	$124.22
28220	Primary closure - lesion base < or = 1 cm	$220.39
28221	Primary closure - additional lision < or = 1 cm	$110.20
28225	Primary closure - lesion base > 1 cm	$434.30
28226	Primary closure - each additional lesion > 1 cm	$217.14
28240	Surface oseous lesions - lesion base < or = 1 cm	$176.28
28241	Surface osseous lesions - additional < or = 1 cm	$88.15
28245	Surface osseous lesions - lesion base > 1 cm	$333.51
28246	Surface osseous lesions - additional lesion > 1 cm	$166.73
28250	Intraosseous lesions - < or = 1 cm in diameter	$220.39
28252	Intraosseous lesions - 1 cm to 5 cm	$434.30
28260	Intraosseous lesions - additional lesion same jaw	$217.15
28265	Intraosseous lesions - additional lesion 2nd jaw	$325.73
28350	Vestibular or subperiosteal abscess	$53.47
28355	Intraoral superficial	$82.80
28365	Extraoral superficial	$122.53
28375	Sequestrectomy for osteomyelitis	$249.87
28100	Alveoloplasty - per edentulous	$98.45
28102	Alveoloplasty - conjunction with multiple extracts	$74.03
28105	Alveoloplasty - tuberosity reduction bone removal	$204.52
28107	Removal of a torus/exostosis - per quadrant	$160.93
28108	Removal of torus/exostosis - palatal torus	$253.81
28213	Removal of foreign body from soft tissue	$92.89
28214	Removal of foreign body from bone	$292.19
28218	Dilation of salivary duct	$39.32
28219	Sialodochoplasty	$121.76
28247	Submandibular	$121.76
28120	Uncomplicated excision of hyperplastic tissue	$90.30
28122	Operculectomy	$42.21
28124	Gingivoplasty - per sextant	$97.78
28128	Frenectomy	$203.86
28129	Frenectomy - second at same surgery	$101.95
28131	Vestibuloplasty - each sextant	$373.58
28132	Vestibuloplasty - mucous membrane graft	$73.03
28300	G.p. surgical assistant	$486.97
28301	After three hours continuous surgical assistance	$24.35
28082	Apicoectomy - bicuspids and buccal roots	$340.89
28084	Apicoectomy - palatal roots of maxillary molars	$325.80
28086	Apicoectomy - per root end fill, add	$32.52
28088	Apicoectomy - hemisection	$121.38
28089	Abscess (acute) drainage in hospital-last resort	$80.03
28090	Root amputations - one root per tooth	$242.77
28092	Root amputations - two roots per tooth	$291.30
28180	Incisional biopsies - soft tissue	$108.44
28182	Incisional biopsies - hard tissue	$194.79
28211	Reduction of dislocation	$121.76
28212	Manipulation under anaesthesia	$121.76
28200	Management of a non-avulsed tooth with wire	$65.83
28201	Additional teeth for management of non-avulsed	$32.92
28202	Removal of splint after stabilization	$50.44
28203	Management of a fractured tooth	$114.96
28204	Additional teeth for mangement of fractured tooth	$60.35
28205	Implantation and splinting of an avulsed tooth	$312.12
28206	Reduction of alveolar fracture	$485.87
28207	Single layer suture of lacaration	$118.67
28208	Closed reduction of maxilla with arch bars	$431.84
28209	Closed reduction of mandible with arch bars	$489.62
28210	Simple fracture of mandible	$634.95

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