D0140 Limited Oral Evaluation - Problem Focused $ 128.00 D0160 Detailed and Extensive Oral Evaluation - Problem Focused Report $ 230.00 D0170 Re-Evaluation - Limited Problem Focused $ 119.00 D7140 Extraction Erupted Tooth or Exposed Root $ 255.00 D7210 Surgical Removal Erupted Tooth Requiring Elevation FLP & Removal Bone $ 377.00 D7220 Removal of Impacted Tooth - Soft Tissue $ 430.00 D7230 Removal of Impacted Tooth - Partially Bony $ 521.00 D7240 Removal of Impacted Tooth - Completely Bony $ 649.00 D7241 Removal Impacted Tooth - Completely Bony w/unusual Surgical Comps $ 735.00 D7250 Surgical Removal of Residual Tooth Roots $ 417.00 D7260 Oroantral Fistula Closure $ 1,200.00 D7261 Primary Closure of a Sinus Perforation $ 800.00 D7270 Tooth Reimplantation and/or Stabilization of Accidentally Evulsed/Displaced Tooth $ 749.00 D7285 Biopsy of Oral Tissue Hard $ 705.00 D7286 Biopsy of Oral Tissue Soft $ 468.00 D7310 Alveoloplasty Conjunction w/extractions - Per Quadrant $ 332.00 D7311 Alveoloplasty Conjunction w/extractions 1-3 Teeth/Spaces Per Quadrant $ 335.00 D7320 Alveoloplasty Not in Conjunction w/extractions - Per Quadrant $ 481.00 D7321 Alveoloplasty Not in Conjunction w/extractions 1-3 Teeth/Spaces Per Quadrant $ 440.00 D7410 Excision of Benign Lesion up to 1.25 CM $ 524.00 D7411 Excision of Benign Lesion Greater than 1.25 CM $ 782.00 D7450 Removal Benign Odontogenic Cyst/Tumor - to 1.25 CM $ 709.00 D7451 Removal Benign Odontogenic Cyst/Tumor > 1.25 CM $ 1,086.00 D7460 Removal of Benign Nonodontogenic Cyst/Tumor - up 1.25 CM $ 680.00 D7461 Removal Benign Nonodontogenic Cyst/Tumor - >1.25 CM
