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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: $31.15 Benefit: 75% = $23.40 85% = $26.50

(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: $187.70 Benefit: 75% = $140.80 85% = $159.55

(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: $185.50 Benefit: 75% = $139.15 85% = $157.70

(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: $237.20 Benefit: 75% = $177.90 85% = $201.65

(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: $264.35 Benefit: 75% = $198.30 85% = $224.70

(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: $310.75 Benefit: 75% = $233.10 85% = $264.15

(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: $310.75 Benefit: 75% = $233.10 85% = $264.15

(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: $463.90 Benefit: 75% = $347.95 85% = $394.35

(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: $393.30 Benefit: 75% = $295.00 85% = $334.35

(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: $263.80 Benefit: 75% = $197.85 85% = $224.25

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

• Previous - Item 75610
• Next - Item 75621