Page 16 of 24 MET245_SOB_CA (01/26) Fs/f GCERT2010-DHMO-SOB sob Code Service Your and Your Dependent's Co-Payment D7251 Coronectomy – intentional partial tooth removal, impacted teeth only: Intentional partial tooth removal is performed when a neurovascular complication is likely if the entire tooth is removed. $80 D7252 Partial extraction for immediate implant placement Sectioning the root of a tooth vertically, then extracting the palatal portion of the root. The buccal section of the root is retained in order to stablize the buccal plate prior to immediate implant placement. Also known as the Socket Shield Technique. $60 D7260 Oroantral fistula closure $270 D7261 Primary closure of a sinus perforation $275 D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth $50 D7280 Exposure of an unerupted tooth $100 D7282 Mobilization of erupted or malpositioned tooth to aid eruption $90 D7283 Placement of an attachment on an unerupted tooth, after its exposure, to aid in its eruption. Report the surgical exposure separately using D7280. $90 D7285 Incisional biopsy of oral tissue - hard (bone, tooth) . For partial removal of lesion. This procedure involves biopsy of osseous or intraosseous lesions (example cyst, tumor) and is not used for apicoectomy/periradicular surgery. This procedure does not entail an excision. $150 D7286 Incisional biopsy of oral tissue – soft. For partial removal of a lesion. This procedure is not used at the same time as codes for apicoectomy/periradicular curettage. This procedure does not entail an excision. $60 D7287 Exfoliative cytological sample collection $50 D7288 Brush biopsy – transepithelial sample collection $50 D7291 Transseptal fiberotomy/supra crestal fiberotomy, by report $40 D7310 Alveoloplasty in conjunction with extractions – four or more teeth or tooth spaces, per quadrant $40 D7311 Alveoloplasty in conjunction with extractions – one to three teeth or tooth spaces, per quadrant $15 D7320 Alveoloplasty not in conjunction with extractions – four or more teeth or tooth spaces, per quadrant $60 D7321 Alveoloplasty not in conjunction with extractions – one to three teeth or tooth spaces, per quadrant $25 D7340 Vestibuloplasty – ridge extension (secondary epithelialization) $370 D7350 Vestibuloplasty – ridge extension (including soft tissue grafts, muscle reattachment, revision of soft tissue attachment and management of hypertrophied and hyperplastic tissue) $990 D7450 Removal of benign odontogenic cyst or tumor – lesion diameter up to 1.25 cm $130 D7451 Removal of benign odontogenic cyst or tumor – lesion diameter greater than 1.25 cm $335 D7471 Removal of lateral exostosis (maxilla or mandible) $80 D7472 Removal of torus palatinus $60 D7473 Removal of torus mandibularis $60 D7485 Reduction of osseous tuberosity $60 D7510 Incision and drainage of abscess – intraoral soft tissue $35