| Code |
Description |
Enrollee Pays |
| D9110 |
Palliative (emergency) treatment of dental pain - minor procedure |
$ 35 |
| D9350 |
Regional block anesthesia |
No Cost |
| D9212 |
Trigeminal division block anesthesia |
No Cost |
| D9215 |
Local anesthesia |
No Cost |
| D9310 |
Consultation - diagnostic service provided by dentist or physician other than requesting dentist or physician |
$ 35 |
| D9430 |
Office visit for observation (during regularly scheduled hours) - no other services performed |
$ 5 |
| D9440 |
Office visit - after regularly scheduled hours |
$ 50 |
| D9999 |
Unspecified adjunctive procedure, by report - includes failed appointment without 24 hour notice - per 15 minutes of appointment time |
$ 15 |
