Periodontal Procedure Codes

 

For a new patient:

The total package of new patient examination, scaling/root planing & re-evaluation is $74:
Patient who requires scaling (pockets < 5 mm): Patient who requires root planing: (pockets > 5 mm ):
01204
New Patient Exam
$37
01204
New Patient Exam
$37
11111
Scaling 1 unit of time
$25
43421
Root planing 1 unit of time
$30
11117
Scaling 1/2 unit of time
$12
43427
Root planing 1/2 unit of time
$16
44103
Periodontal Re-evaluation
$0
44103
Periodontal Re-evaluation
$0
Total
$74
Total
$83
 

For a recall patient:

The total package of examination & scaling/root planing is $53:

Patient who requires scaling: Patient who requires root planing:
01202
Oral Exam - Recall
$16
01202
Oral Exam - Recall
$16
11111
Scaling 1 unit of time
$25
43421
Root planing 1 unit of time
$30
11117
Scaling 1/2 unit of time
$12
43427
Root planing 1/2 unit of time
$16
Total
$53
Total
$62
   

Additional codes - (no grade required) :

Y1087 Observe

Y1700 Perio surgery assist.

Y1800 Perio surgery observe.

Y1900 Perio non-surgical assist.

Y4301 Patient missed or cancelled appointment