D9110*

Emergency service only. The type of treatment rendered and TID must be indicated. It must be a service other than a prescription or topical medication. The reason for emergency and a narrative of the procedure actually performed must be documented. Refer to section 19.6. A 1-20, N

D9120

Not considered medically necessary.

Providers must comply with TSBDE Rules, 22 TAC §§108.30-108.35. Any anesthesia type services are paid only to the provider. Criteria for dental therapy under general anesthesia must be used (see page 19-33). A local anesthesia fee is not paid in addition to other restorative, operative, or surgical procedure fees. Prior authorization is available for exceptions to periodicity.

D9210

Claim form narrative should describe the situation if used as a diagnostic tool. A 1-20, N, CCP

D9211*

A 1-20, N, CCP

D9212*

A 1-20, N, CCP

D9215*

Claim form narrative should explain how the doctor initiated a procedure, but could not complete it, and needs to claim the rendered anesthesia. A 1-20, N, CCP

D9220

May not be billed with codes D9230 or D9610. Can only be billed with D9221. May be billed twice within a 12-month period. A 1-20

D9221

May not be billed with codes D9230 or D9610. Can only be billed with D9220. A 1-20

D9230*

May not be billed with code D9220, D9221, D9610, or D9920. May not be billed more than one per client, per day. A 1-20.

D9241

May not be billed with code D9220 or D9221. May not be billed on the same date of service as D9920. May be considered for reimbursement for additional conscious sedation services. A 1-20

D9242

May be considered for reimbursement for additional conscious sedation services when billing with procedure code D9242.
A 1-20

D9248*

May be billed twice within a 12-month period. Must comply with all TSBDE rules, including maintaining a current permit to provide non-IV conscious sedation. A 1-20

D9310

An oral evaluation by a specialist of any type who is also providing restorative or surgical services should be billed as D0160. A 1-20, N, CCP

D9410

Narrative required on claim form. A 1-20

D9420

One charge per hospital or ASC case; one case per client in a 12-month period. Documentation supporting the reason that dental services could not be performed in the office setting must be retained in the client's record and may be subject to retrospective review and recoupment. A 1-20, N

D9430

Narrative required on claim form. Visits for routine postoperative care are included in all therapeutic and oral surgery fees. A 1-20, N

D9440

Narrative required on claim form. Visits for routine postoperative care are included in all therapeutic and oral surgery fees. A 1-20, N

D9450

Deny as global to other services.

D9610

Providers must comply with TSBDE Rules and Regulations. May not be billed with code D9220, D9221, or D9920. A 1-20, N

D9612

Not considered medically necessary.

D9630

May not be billed with codes D9220, D9221, D9230, D9241, D9248, D9610, and D9920. A 1-20, N

D9910

Per whole mouth application, does not include fluoride. Restricted to once per year. A 18-20, N, CCP

D9911

Denied as part of D9910.

D9920

The provider must indicate on the claim the client's medical diagnosis of mental retardation or that the client is ICF-MR eligible. A 1-20

D9930*

A 1-20, N

D9940

A 13-20, N, CCP

D9950

A 13-20, N, CCP

D9951

Full mouth procedure. Limited to once per year, per client, any provider. A 13-20, N, CCP

D9952

Full mouth procedure. Payable once per lifetime, any provider. A 13-20, N, CCP

D9970

Not considered medically necessary.

D9971

Not considered medically necessary.

D9972

Not considered medically necessary.

D9973

Not considered medically necessary.

D9974*

Must include documentation of medical necessity.
A 13-20, CCP

D9999*

A 1-20, N, CCP, PPXR