CSHCN 2009 > Dental > Claims Information

   
 

14.3.3 Supernumerary Tooth Identification

Each identified permanent tooth and each identified primary tooth has its own identifiable supernumerary number. This developed system can be found in the 2007-2008 CDT published by the ADA.

The TID for each identified supernumerary tooth is used for paper and electronic claims and can only be billed with the following codes:

For primary teeth only: D7111

For both primary and permanent teeth the following codes are billable: D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7285, D7286, and D7510

Permanent Teeth Upper Arch

Tooth #

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

Super #

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

Permanent Teeth Lower Arch

Tooth #

32

31

30

29

28

27

26

25

24

23

22

21

20

19

18

17

Super #

82

81

80

79

78

77

76

75

74

73

72

71

70

69

68

67

Primary Teeth Upper Arch

Tooth #

A

B

C

D

E

F

G

H

I

J

Super #

AS

BS

CS

DS

ES

FS

GS

HS

IS

JS

Primary Teeth Lower Arch

Tooth #

T

S

R

Q

P

O

N

M

L

K

Super #

TS

SS

RS

QS

PS

OS

NS

MS

LS

KS

Providers billing for dental services may bill electronically or use the ADA Dental Claim Form.

Refer to: Chapter 5, "Instructions for Completing the ADA Dental Claim Form".


Texas Medicaid & Healthcare Partnership
CPT only copyright 2008 American Medical Association. All rights reserved.
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