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19.18.7 Orthodontic Procedure Codes and Fee Schedule

When submitting claims for orthodontic procedures, use the following procedure codes:

Procedure Code
Limitations
Maximum Fee
Orthodontic Services

D0330*, D0340*, D0350*, and D0470*

When requested orthodontic cases are submitted for authorization and denied, two out of ten denials will be paid. These four procedure codes, when billed together for denied cases, replace local procedure code Z2010.

$100.00

D7280

A 1 - 20

$62.50

D7997*

Replaces Z2016. Not payable to the dentist who placed the appliance. Includes removal of arch bar and premature removal of braces. A 1 - 20

$50.00
Interceptive Orthodontic Treatment

D8050*

Replaces Z2018 and 8110D. Limited to one per lifetime.

$340.00

D8060*

Replaces Z2018 and 8120D. Limited to one per lifetime.

$340.00

D8080*

Replaces Z2009, Z2011, and Z2012. Limited to one per lifetime.

$775.00
Minor Treatment to Control Harmful Habits

D8210*

See separate table for associated remarks field code.

See separate table

D8220*

See separate table for associated remarks field code.

See separate table
Other Orthodontic Services

D8660*

Replaces Z2008.

$15.00

D8670*

Replaces Z2013.

$68.10

D8680*

Replaces Z2014 and Z2015.

$100.00

D8690*

Bracket replacement.

$20.00

D8691

Not considered medically necessary.

NC

D8692

Limited to one service per arch per lifetime for each retainer.

NC

D8999

 
Manually priced
* = Services payable to an FQHC for a client encounter.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2007 American Medical Association. All rights reserved.
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