New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 56 - MANUAL FOR DENTAL SERVICES
Subchapter 3 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)
Section 10:56-3.9 - D6000-D6999 PROSTHODONTICS, FIXED
Universal Citation: NJ Admin Code 10:56-3.9
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Each abutment and each pontic constitutes a unit in a bridge.
1. The Noble Metal Classification System has been adopted as a more precise method of reporting various alloys used in dentistry. The alloys are defined on the basis of the percentage of noble metal content.
| High | Predominantly | ||
| Noble | Noble | Base | |
| Classification | Alloy | Alloy | Alloy |
| Weight % | Au., Pd. and/or | Au., Pd. and/or | Au., Pd. and/or |
| Pt. > 60% (with | Pt. > 25% | Pt. < 25% | |
| at least 40% Au) |
2. There is only one fee for each type of pontic or crown. Use the type of alloy most appropriate for the patient's needs.
Implant services:
| Maximum Fee | ||||||
| HCPCS | Allowance | |||||
| IND | Code | Mod | Procedure Description | S | $ | NS |
| * | D6010 | Surgical placement of implant | 500.00 | 500.00 | ||
| body: endosteal implant | ||||||
| * | D6056 | Prefabricated abutment | 76.00 | 70.00 | ||
| * | D6059 | Abutment supported porcelain fused | 279.00 | 253.00 | ||
| to metal crown (high noble metal) | ||||||
| * | D6060 | Abutment supported porcelain fused | 279.00 | 253.00 | ||
| to metal crown (predominantly base | ||||||
| metal) | ||||||
| * | D6061 | Abutment supported porcelain fused | 279.00 | 253.00 | ||
| to metal crown (noble metal) | ||||||
| * | D6062 | Abutment supported cast metal | 161.00 | 140.00 | ||
| crown (high noble metal) | ||||||
| * | D6063 | Abutment supported cast metal | 161.00 | 140.00 | ||
| crown (predominantly base metal) | ||||||
| * | D6064 | Abutment supported cast metal | 161.00 | 140.00 | ||
| crown (noble metal) | ||||||
| * | D6066 | Implant supported porcelain fused | 279.00 | 253.00 | ||
| to metal crown (titanium, titanium | ||||||
| alloy, high noble metal) | ||||||
| * | D6067 | Implant supported metal crown | 161.00 | 140.00 | ||
| (titanium, titanium alloy, high | ||||||
| noble metal) | ||||||
| * | D6069 | Abutment supported retainer for | 279.00 | 253.00 | ||
| porcelain fused to metal FPD (high | ||||||
| noble metal) | ||||||
| * | D6070 | Abutment supported retainer for | 279.00 | 256.00 | ||
| porcelain fused to metal FPD | ||||||
| (predominantly base metal) | ||||||
| * | D6071 | Abutment supported retainer for | 279.00 | 256.00 | ||
| porcelain fused to metal FPD | ||||||
| (noble metal) | ||||||
| * | D6072 | Abutment supported retainer for | 161.00 | 140.00 | ||
| cast metal FPD (high noble metal) | ||||||
| * | D6073 | Abutment supported retainer for | 161.00 | 140.00 | ||
| cast metal FPD (predominantly base | ||||||
| metal) | ||||||
| * | D6074 | Abutment supported retainer for | 161.00 | 140.00 | ||
| cast metal FPD (noble metal) | ||||||
| * | D6199 | Unspecified implant procedure, by | BR | BR | ||
| report | ||||||
(b) Bridge pontics:
| Maximum Fee | ||||||
| HCPCS | Allowance | |||||
| IND | Code | Mod | Procedure Description | S | $ | NS |
| * | D6210 | Pontic--Cast High Noble Metal | 76.00 | 66.00 | ||
| * | D6211 | Pontic--Cast Predominantly Base | 76.00 | 66.00 | ||
| Metal | ||||||
| * | D6212 | Pontic--Cast Noble Metal | 76.00 | 66.00 | ||
| * | D6240 | Pontic--Porcelain Fused to High | 170.00 | 165.00 | ||
| Noble Metal | ||||||
| * | D6241 | Pontic--Porcelain Fused to | 170.00 | 165.00 | ||
| Predominantly Base Metal | ||||||
| * | D6242 | Pontic--Porcelain Fused to Noble | 170.00 | 165.00 | ||
| Metal | ||||||
| * | D6250 | Pontic--Resin with High Noble Metal | 90.00 | 80.00 | ||
| * | D6251 | Pontic Resin with Predominantly | 90.00 | 80.00 | ||
| Base Metal | ||||||
| * | D6252 | Pontic--Resin with Noble Metal | 90.00 | 80.00 | ||
| * | D6545 | Retainer--cast metal for resin | 75.00 | 75.00 | ||
| bonded fixed prosthesis | ||||||
NOTE: Per tooth.
(c) Bridge retainers--crowns:
| * | D6720 | Crown--Resin with High Noble Metal | 161.00 | 140.00 |
| * | D6721 | Crown--Resin with Predominantly | 161.00 | 140.00 |
| Base Metal | ||||
| * | D6722 | Crown--Resin with Noble Metal | 161.00 | 140.00 |
| * | D6750 | Crown--Porcelain Fused to High | 279.00 | 253.00 |
| Noble Metal | ||||
| * | D6751 | Crown--Porcelain Fused to | 279.00 | 253.00 |
| Predominantly Base Metal | ||||
| * | D6752 | Crown--Porcelain Fused to Noble | 279.00 | 253.00 |
| Metal | ||||
| * | D6790 | Crown--Full Cast High Noble Metal | 161.00 | 140.00 |
| * | D6791 | Crown--Full Cast Predominantly | 161.00 | 140.00 |
| Base Metal | ||||
| * | D6792 | Crown--Full Cast Noble Metal | 161.00 | 140.00 |
(d) Other fixed prosthetic services:
| D6930 | Recement Bridge | 8.00 | 7.00 |
NOTE 1: One abutment.
NOTE 2: Code may be used when recementing facing.
| D6930 | 22 | Recement Bridge | 14.00 | 12.00 |
NOTE: Two or more abutments.
| * | D6970 | Cast Post and Core in Addition to | 75.00 | 68.00 |
| Bridge Retainer |
NOTE 1: Post and core fabricated (cast) and cemented as a separate unit from crown.
NOTE 2: Not in conjunction with Procedure Codes D3950 and D3950 22.
| * | D6972 | Prefabricated Post and Core in | 49.00 | 45.00 |
| Addition to Bridge Retainer |
NOTE: Not in conjunction with Procedure Codes D3950 and D3950 22.
| D6973 | Core build up for retainer, | 49.00 | 45.00 | |
| including any pins | ||||
| * | D6975 | Coping--metal | 161.00 | 140.00 |
NOTE: Cast crown.
| * | D6980 | Bridge Repair, By Report | BR | BR |
| * | D6999 | Unspecified Fixed Prosthodontic | BR | BR |
| Procedure, By Report |
Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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