New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 56 - MANUAL FOR DENTAL SERVICES
Subchapter 3 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)
Section 10:56-3.3 - D1000-D1999 PREVENTIVE
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Dental prophylaxis:
NOTE: Patients 16 years of age or older, maxillary and mandibular arches; includes additional scaling.
NOTE 1: Patients 16 years of age or older, maxillary or mandibular arch, includes additional scaling.
NOTE 2: Code to be used if patient is edentulous in one arch.
NOTE: Patients up to and including 15 years of age, maxillary and mandibular arches; includes additional scaling, includes additional scaling.
NOTE: Patients 16 years of age or older, maxillary and mandibular arches.
NOTE: Patients up to and including 15 years of age, maxillary and mandibular arches.
(b) Topical fluoride treatment (office procedure):
NOTE: Patients up to and including 15 years of age, maxillary and mandibular arches.
NOTE: Patients up to and including 15 years of age, maxillary and mandibular arches.
NOTE: Patients age 16 up to and including 20 years of age, maxillary and mandibular arches.
NOTE: Patients age 16 up to and including 20 years of age, maxillary and mandibular arches.
NOTE: Patients age 16 up to and including 20 years of age, maxillary or mandibular arch. Code to be used if patient is edentulous in one arch.
NOTE: Patients up to and including 15 years of age, maxillary and mandibular arches.
NOTE: Patients age 16 up to and including 20 years of age, maxillary and mandibular arches.
(c) Other Preventive Services
NOTE 1: Unfilled premolars and permanent molars.
NOTE 2: Beneficiaries up to and including 16 years of age.
(d) Space Maintenance (passive appliances)
NOTE: Utilizing band(s) or stainless steel crowning.
NOTE: Lingual or palatal arch utilizing bands or stainless steel crowning.
NOTE: The complete description of procedure(s) and the reason(s) the procedure was performed must be included in the report.