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D7250 Removal of residual tooth roots (cutting procedure) $180D7251 Coronectomy %u2014 intentional partial tooth removal $500D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth $380D7280 Exposure of an unerupted tooth $240D7282 Mobilization of erupted or malpositioned tooth to aid eruption $260D7283 Placement of device to facilitate eruption of impacted tooth $85D7286 Incisional biopsy of oral tissue %u2014 soft %u2014 does not include pathology laboratory procedures $120D7310 Alveoloplasty in conjunction with extractions %u2014 four or more teeth or tooth spaces, per quadrant $70D7311 Alveoloplasty in conjunction with extractions %u2014 one to three teeth or tooth spaces, per quadrant $90D7320 Alveoloplasty not in conjunction with extractions %u2014 four or more teeth or tooth spaces, per quadrant $350D7321 Alveoloplasty not in conjunction with extractions %u2014 one to three teeth or tooth spaces, per quadrant $300D7450 Removal of benign odontogenic cyst or tumor %u2014 lesion diameter up to 1.25 cm $185D7451 Removal of benign odontogenic cyst or tumor %u2014 lesion diameter greater than 1.25 cm $265D7471 Removal of lateral exostosis (maxilla or mandible) $250D7472 Removal of torus palatinus $320D7473 Removal of torus mandibularis $320D7510 Incision and drainage of abscess %u2014 intraoral soft tissue $65D7511 Incision and drainage of abscess %u2014 intraoral soft tissue %u2014 complicated (includes drainage of mulitple fascial spaces) $0D7960 Frenulectomy %u2014 also known as frenectomy or frenotomy %u2014 separate procedure not incidental to another procedure $145D7970 Excision of hyperplastic tissue %u2014 per arch $290D7971 Excision of pericoronal gingiva $150Adjunctive General ServicesD9110 Palliative (emergency) treatment of dental pain %u2014 minor procedure $35D9211 Regional block anesthesia $35D9212 Trigeminal division block anesthesia $110D9215 Local anesthesia in conjunction with operative or surgical procedures $45D9219 Evaluation for deep sedation or general anesthesia $30D9223 Deep sedation/general anesthesia %u2014 each 15-minute increment $85D9230 Analgesia, anxiolysis, inhalation of nitrous oxide $44D9243 Intravenous moderate (conscious) sedation/analgesia %u2014 each 15-minute increment $100D9248 Non-intravenous conscious sedation $80D9310 Consultation %u2014 diagnostic service provided by dentist or physician other than requesting dentist or physician $50D9430 Office visit for observation (during regularly scheduled hours) %u2014 no other services performed $45D9440 Office visit %u2014 after regularly scheduled hours $110D9932 Cleaning and inspection of removable denture, maxillary $20D9933 Cleaning and inspection of removable complete denture, mandibular $20D9934 Cleaning and inspection of removable partial denture, maxillary $20D9935 Cleaning and inspection of removable partial denture, mandibular $20D9940 Occlusal guard, by report %u2014 limited to 1 in 3 years $250D9943 Occlusal guard adjustment $35D9951 Occlusal adjustment, limited $50D9952 Occlusal adjustment, complete $150D9975 External bleaching for home application, per arch; includes materials and fabrication of custom trays %u2014 limited to one bleaching tray and gel for two weeks of self-treatment$120D9986 Missed appointment %u2014 without 24-hour notice %u2014 per 15 minutes of appointment time $25D9987 Canceled appointment %u2014 without 24-hour notice %u2014 per 15 minutes of appointment time $20Orthodontics Orthodontic treatment under age 19 VariableOrthodontic treatment over age 19 VariableThe listed co-payment for each phase of orthodontic treatment (limited, interceptive, or comprehensive) covers up to 24 months of active treatment. Beyond 24 months, an additional monthly fee, not to exceed $125, may apply.New Jersey: 1-800-722-3524 Out of State: 1-800-848-3524%u00a9 2022 Delta Dental of New Jersey04-202235