TMPPM 2011 > Children's Services Handbook > Texas Health Steps (THSteps) Dental > Services/Benefits, Limitations, and Prior Authorization > Tooth Identification (TID) and Surface Identification (SID) Systems > Supernumerary Tooth Identification

   
 

4.2.9.1 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 CDT published by the ADA.

The TID for each identified supernumerary tooth will be used for paper and electronic claims and can only be submitted for payment with the following procedure codes:

For primary teeth only: D7111.

For both primary and permanent teeth the following codes can be submitted: 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


Texas Medicaid & Healthcare Partnership
CPT only copyright 2010 American Medical Association. All rights reserved.
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