MSP Billing Codes

Specialty: Dental Technical Procedures

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Code	Description	Fee
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Appliances - Removable / Retention (Splint)
03825	Appliances, removable, retention (splint) mandibul	$316.85
03824	Appliances, removable, retention (splint) maxillar	$316.85
03826	Appliances/removable/retention(splint) - palatal	$63.36
Cephalometric Radiographs
03804	Cephalometric radiographs pre-treatment post-treat	$40.97
03805	Cephalometric radiographs pre-treatment post-treat	$67.87
03806	Cephalometric radiographs pre-treatment post-treat	$26.91
03807	Cephalometric tracing/interpretation pre-treatment	$76.05
Intraoral Radiographs
03841	Occlusal - single film	$20.91
03842	Occlusal - two films	$30.93
03835	Periapical - five films	$39.99
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03834	Periapical - four films	$34.03
03831	Periapical - single film	$16.00
03836	Periapical - six films	$46.00
03833	Periapical - three films	$28.03
03832	Periapical - two films	$22.05
Miscellaneous
03803	Panoramic radiographs pre-treatment post-treatment	$62.74
Radiographs / Duplications
03820	Casts, diagnostic, mounted using facebow and occlu	$301.28
03819	Casts, diagnostic, mounted, one or more sets maybe	$82.53
03822	Diagnostic (ghathological wax-up) model surgery tw	$152.10
03821	Diagnostic (gnathological wax-up) model surgery on	$76.05
03823	Diagnostic (gnathological wax-up) model surgery th	$228.14
03817	Diagnostic models, upper and lower	$69.43
03818	Duplicate models, upper and lower	$38.03
03816	Photographs, each additional	$5.45
03815	Photographs, first photograph	$16.41
03847	Radiographs/duplications - each additional	$4.20
03844	Radiographs/duplications - single film	$7.36
03846	Radiographs/duplications - three films	$21.88
03845	Radiographs/duplications - two films	$14.50
TMJ Radiographs
03830	Tmj radiographs - each additional film over four	$26.91
03811	Tmj radiographs, radiographs, tmj one film	$40.97
03814	Tmj radiographs, radiographs, tmj, four films	$124.21
03813	Tmj radiographs, radiographs, tmj, three films	$94.54
03812	Tmj radiographs, radiographs, tmj, two films	$67.87
03809	Tmj radiographs, tomography, single view	$56.31
03810	Tmj radiographs, tomography, two views	$70.56

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