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Removal of each additional tooth or tooth fragment if provided in association with a service to which item 75200 or 75203 applies

Fee: $30.10 Benefit: 75% = $22.60 85% = $25.60

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

• Previous - Item 75203
• Next - Item 75400

Surgical removal of erupted tooth

Fee: $181.35 Benefit: 75% = $136.05 85% = $154.15

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

• Previous - Item 75206
• Next - Item 75402

Surgical removal of tooth, or tooth fragment requiring incision of soft tissue only

Fee: $179.25 Benefit: 75% = $134.45 85% = $152.40

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

• Previous - Item 75400
• Next - Item 75405

Surgical removal of tooth, or tooth fragment requiring removal of bone, where the patient is referred by a referring dentist or medical practitioner

Fee: $229.20 Benefit: 75% = $171.90 85% = $194.85

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

• Previous - Item 75402
• Next - Item 75600

Surgical exposure and packing of unerupted tooth

Fee: $255.40 Benefit: 75% = $191.55 85% = $217.10

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

• Previous - Item 75405
• Next - Item 75603

Surgical exposure of unerupted tooth for the purpose of fitting a traction device or placement of a temporary anchorage device

Fee: $300.25 Benefit: 75% = $225.20 85% = $255.25

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

• Previous - Item 75600
• Next - Item 75606

Surgical repositioning of unerupted tooth where the patient is referred by a referring dentist or medical practitioner

Fee: $300.25 Benefit: 75% = $225.20 85% = $255.25

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

• Previous - Item 75603
• Next - Item 75609

Transplantation of tooth bud where the patient is referred by a referring dentist or medical practitioner

Fee: $448.20 Benefit: 75% = $336.15 85% = $381.00

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

• Previous - Item 75606
• Next - Item 75610

Surgical procedure for intraoral implantation of an osseointegrated fixture and placement of transmucosal abutments where the patient is referred by a referring dentist or medical practitioner

Fee: $380.00 Benefit: 75% = $285.00 85% = $323.00

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

• Previous - Item 75609
• Next - Item 75618

Fabrication and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome

Fee: $254.90 Benefit: 75% = $191.20 85% = $216.70

(See para CN.2.1 of explanatory notes to this Category)

• Previous - Item 75610
• Next - Item 75621