NJ PIP Fee Schedule Exhibit 2: Dental Fees
Exhibit 2 prices dental treatment after an automobile accident. Its 323 rows are CDT codes rather than CPT, and each carries a North and a South New Jersey amount. Dental is the one exhibit whose source file prints no copyright notice, although the rule itself makes CDT the American Dental Association's property.
The schedule001
Exhibit 2 in full, all 323 rows
How to read this table
- Code
- A CDT code, the American Dental Association's coding system, not CPT. 11:3-29.2 fixes the edition as CDT 2011-2012.
- North, South
- The fee, chosen by the region where the treatment was given (11:3-29.3(a), which names Exhibit 2 explicitly).
- n/a
- Printed by the State in the cell, not an omission and not a blank. Two codes carry it, both explained below.
D0: diagnostic
28 rows| CDT | Description | North | South |
|---|---|---|---|
| D0120 | periodic oral evaluation - established patient | $59.00 | $52.00 |
| D0140 | limited oral evaluation - problem focused | $91.00 | $80.00 |
| D0150 | comprehensive oral evaluation - new or established patient | $104.00 | $92.00 |
| D0160 | detailed and extensive oral evaluation - problem focused, by report | $190.00 | $168.00 |
| D0170 | re-evaluation - limited, problem focused (established patient; not post-operative visit) | $85.00 | $75.00 |
| D0180 | comprehensive periodontal evaluation - new or established patient | $113.00 | $100.00 |
| D0210 | intraoral - complete series (including bitewings) | $153.00 | $135.00 |
| D0220 | intraoral - periapical first film | $34.00 | $30.00 |
| D0230 | intraoral - periapical each additional film | $28.00 | $25.00 |
| D0240 | intraoral - occlusal film | $51.00 | $45.00 |
| D0250 | extraoral - first film | $80.00 | $71.00 |
| D0260 | extraoral - each additional film | $68.00 | $60.00 |
| D0270 | bitewing - single film | $34.00 | $30.00 |
| D0272 | bitewings - two films | $53.00 | $47.00 |
| D0273 | bitewings - three films | $67.00 | $59.00 |
| D0274 | bitewings - four films | $78.00 | $69.00 |
| D0277 | vertical bitewings - 7 to 8 films | $119.00 | $105.00 |
| D0290 | posterior-anterior or lateral skull and facial bone survey film | $164.00 | $145.00 |
| D0320 | temporomandibular joint arthrogram, including injection | $714.00 | $632.00 |
| D0321 | other temporomandibular joint films, by report | $248.00 | $219.00 |
| D0330 | panoramic film | $130.00 | $115.00 |
| D0340 | cephalometric film | $147.00 | $130.00 |
| D0350 | oral/facial photographic images | $88.00 | $78.00 |
| D0360 | cone beam ct - craniofacial data capture | $691.00 | $611.00 |
| D0362 | cone beam - two-dimensional image reconstruction using existing data, includes multiple images | $448.00 | $397.00 |
| D0363 | cone beam - three-dimensional image reconstruction using existing data, includes multiple images | $482.00 | $427.00 |
| D0460 | pulp vitality tests | $67.00 | $59.00 |
| D0470 | diagnostic casts | $135.00 | $119.00 |
D1: preventive
9 rows| CDT | Description | North | South |
|---|---|---|---|
| D1110 | prophylaxis - adult | $108.00 | $95.00 |
| D1120 | prophylaxis - child | $79.00 | $70.00 |
| D1351 | sealant - per tooth | $65.00 | $57.00 |
| D1510 | space maintainer - fixed - unilateral | $374.00 | $330.00 |
| D1515 | space maintainer - fixed - bilateral | $509.00 | $451.00 |
| D1520 | space maintainer - removable - unilateral | $457.00 | $405.00 |
| D1525 | space maintainer - removable - bilateral | $578.00 | $512.00 |
| D1550 | re-cementation of space maintainer | $101.00 | $89.00 |
| D1555 | removal of fixed space maintainer | $93.00 | $82.00 |
D2: restorative
75 rows| CDT | Description | North | South |
|---|---|---|---|
| D2140 | amalgam - one surface, primary or permanent | $169.00 | $149.00 |
| D2150 | amalgam - two surfaces, primary or permanent | $213.00 | $188.00 |
| D2160 | amalgam - three surfaces, primary or permanent | $256.00 | $226.00 |
| D2161 | amalgam - four or more surfaces, primary or permanent | $305.00 | $269.00 |
| D2330 | resin-based composite - one surface, anterior | $190.00 | $168.00 |
| D2331 | resin-based composite - two surfaces, anterior | $238.00 | $210.00 |
| D2332 | resin-based composite - three surfaces, anterior | $298.00 | $263.00 |
| D2335 | resin-based composite - four or more surfaces or involving incisal angle (anterior) | $374.00 | $330.00 |
| D2390 | resin-based composite crown, anterior | $549.00 | $486.00 |
| D2391 | resin-based composite - one surface, posterior | $209.00 | $185.00 |
| D2392 | resin-based composite - two surfaces, posterior | $276.00 | $244.00 |
| D2393 | resin-based composite - three surfaces, posterior | $338.00 | $299.00 |
| D2394 | resin-based composite - four or more surfaces, posterior | $408.00 | $361.00 |
| D2410 | gold foil - one surface | $772.00 | $683.00 |
| D2420 | gold foil - two surfaces | $860.00 | $761.00 |
| D2430 | gold foil - three surfaces | $938.00 | $830.00 |
| D2510 | inlay - metallic - one surface | $1,019.00 | $901.00 |
| D2520 | inlay - metallic - two surfaces | $1,073.00 | $949.00 |
| D2530 | inlay - metallic - three or more surfaces | $1,135.00 | $1,005.00 |
| D2542 | onlay - metallic-two surfaces | $1,183.00 | $1,047.00 |
| D2543 | onlay - metallic-three surfaces | $1,200.00 | $1,062.00 |
| D2544 | onlay - metallic-four or more surfaces | $1,224.00 | $1,083.00 |
| D2610 | inlay - porcelain/ceramic - one surface | $1,070.00 | $946.00 |
| D2620 | inlay - porcelain/ceramic - two surfaces | $1,142.00 | $1,011.00 |
| D2630 | inlay - porcelain/ceramic - three or more surfaces | $1,189.00 | $1,052.00 |
| D2642 | onlay - porcelain/ceramic - two surfaces | $1,193.00 | $1,056.00 |
| D2643 | onlay - porcelain/ceramic - three surfaces | $1,245.00 | $1,102.00 |
| D2644 | onlay - porcelain/ceramic - four or more surfaces | $1,302.00 | $1,152.00 |
| D2650 | inlay - resin-based composite - one surface | $1,041.00 | $921.00 |
| D2651 | inlay - resin-based composite - two surfaces | $1,070.00 | $946.00 |
| D2652 | inlay - resin-based composite - three or more surfaces | $1,108.00 | $980.00 |
| D2662 | onlay - resin-based composite - two surfaces | $1,121.00 | $991.00 |
| D2663 | onlay - resin-based composite - three surfaces | $1,168.00 | $1,034.00 |
| D2664 | onlay - resin-based composite - four or more surfaces | $1,223.00 | $1,082.00 |
| D2710 | crown - resin-based composite (indirect) | $1,123.00 | $993.00 |
| D2712 | crown - 3/4 resin-based composite (indirect) | $1,197.00 | $1,059.00 |
| D2720 | crown - resin with high noble metal | $1,245.00 | $1,102.00 |
| D2721 | crown - resin with predominantly base metal | $1,189.00 | $1,052.00 |
| D2722 | crown - resin with noble metal | $1,201.00 | $1,063.00 |
| D2740 | crown - porcelain/ceramic substrate | $1,358.00 | $1,202.00 |
| D2750 | crown - porcelain fused to high noble metal | $1,302.00 | $1,152.00 |
| D2751 | crown - porcelain fused to predominantly base metal | $1,245.00 | $1,102.00 |
| D2752 | crown - porcelain fused to noble metal | $1,247.00 | $1,104.00 |
| D2780 | crown - 3/4 cast high noble metal | $1,250.00 | $1,106.00 |
| D2781 | crown - 3/4 cast predominantly base metal | $1,215.00 | $1,075.00 |
| D2782 | crown - 3/4 cast noble metal | $1,202.00 | $1,064.00 |
| D2783 | crown - 3/4 porcelain/ceramic | $1,297.00 | $1,148.00 |
| D2790 | crown - full cast high noble metal | $1,305.00 | $1,155.00 |
| D2791 | crown - full cast predominantly base metal | $1,189.00 | $1,052.00 |
| D2792 | crown - full cast noble metal | $1,238.00 | $1,096.00 |
| D2794 | crown - titanium | $1,280.00 | $1,133.00 |
| D2799 | provisional crown | $526.00 | $466.00 |
| D2910 | recement inlay, onlay, or partial coverage restoration | $130.00 | $115.00 |
| D2915 | recement cast or prefabricated post and core | $135.00 | $119.00 |
| D2920 | recement crown | $130.00 | $115.00 |
| D2930 | prefabricated stainless steel crown - primary tooth | $321.00 | $284.00 |
| D2931 | prefabricated stainless steel crown - permanent tooth | $386.00 | $342.00 |
| D2932 | prefabricated resin crown | $417.00 | $369.00 |
| D2933 | prefabricated stainless steel crown with resin window | $440.00 | $390.00 |
| D2934 | prefabricated esthetic coated stainless steel crown - primary tooth | $432.00 | $383.00 |
| D2940 | protective restoration | $146.00 | $129.00 |
| D2950 | core buildup, including any pins | $323.00 | $285.00 |
| D2951 | pin retention - per tooth, in addition to restoration | $89.00 | $79.00 |
| D2952 | post and core in addition to crown, indirectly fabricated | $504.00 | $446.00 |
| D2953 | each additional indirectly fabricated post - same tooth | $374.00 | $330.00 |
| D2954 | prefabricated post and core in addition to crown | $396.00 | $351.00 |
| D2955 | post removal (not in conjunction with endodontic therapy) | $350.00 | $309.00 |
| D2957 | each additional prefabricated post - same tooth | $243.00 | $215.00 |
| D2960 | labial veneer (resin laminate) - chairside | $797.00 | $705.00 |
| D2961 | labial veneer (resin laminate) - laboratory | $1,160.00 | $1,027.00 |
| D2962 | labial veneer (porcelain laminate) - laboratory | $1,360.00 | $1,203.00 |
| D2970 | temporary crown (fractured tooth) | $453.00 | $401.00 |
| D2971 | additional procedures to construct new crown under existing partial denture framework | $246.00 | $217.00 |
| D2975 | coping | $717.00 | $634.00 |
| D2980 | crown repair, by report | $351.00 | $310.00 |
D3: endodontics
3 rows| CDT | Description | North | South |
|---|---|---|---|
| D3310 | endodontic therapy, anterior tooth (excluding final restoration) | $865.00 | $765.00 |
| D3320 | endodontic therapy, bicuspid tooth (excluding final restoration) | $996.00 | $881.00 |
| D3330 | endodontic therapy, molar (excluding final restoration) | $1,198.00 | $1,060.00 |
D4: periodontics
9 rows| CDT | Description | North | South |
|---|---|---|---|
| D4210 | gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant | $764.00 | $676.00 |
| D4249 | clinical crown lengthening - hard tissue | $912.00 | $807.00 |
| D4260 | osseous surgery (including flap entry and closure) - four or more contiguous teeth or tooth bounded spaces per quadrant | $1,272.00 | $1,126.00 |
| D4261 | osseous surgery (including flap entry and closure) - one to three contiguous teeth or tooth bounded spaces per quadrant | $1,075.00 | $951.00 |
| D4263 | bone replacement graft - first site in quadrant | $851.00 | $753.00 |
| D4341 | periodontal scaling and root planing - four or more teeth per quadrant | $300.00 | $265.00 |
| D4355 | full mouth debridement to enable comprehensive evaluation and diagnosis | $217.00 | $192.00 |
| D4381 | localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth, by report | $180.00 | $159.00 |
| D4910 | periodontal maintenance | $166.00 | $147.00 |
D5: removable prosthodontics
45 rows| CDT | Description | North | South |
|---|---|---|---|
| D5110 | complete denture - maxillary | $2,038.00 | $1,803.00 |
| D5120 | complete denture - mandibular | $2,042.00 | $1,807.00 |
| D5130 | immediate denture - maxillary | $2,207.00 | $1,953.00 |
| D5140 | immediate denture - mandibular | $2,207.00 | $1,953.00 |
| D5211 | maxillary partial denture - resin base (including any conventional clasps, rests and teeth) | $1,613.00 | $1,427.00 |
| D5212 | mandibular partial denture - resin base (including any conventional clasps, rests and teeth) | $1,613.00 | $1,427.00 |
| D5213 | maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) | $2,126.00 | $1,881.00 |
| D5214 | mandibular partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) | $2,126.00 | $1,881.00 |
| D5510 | repair broken complete denture base | $252.00 | $223.00 |
| D5520 | replace missing or broken teeth - complete denture (each tooth) | $223.00 | $197.00 |
| D5610 | repair resin denture base | $242.00 | $214.00 |
| D5620 | repair cast framework | $345.00 | $305.00 |
| D5630 | repair or replace broken clasp | $316.00 | $279.00 |
| D5640 | replace broken teeth - per tooth | $218.00 | $193.00 |
| D5650 | add tooth to existing partial denture | $267.00 | $236.00 |
| D5660 | add clasp to existing partial denture | $323.00 | $285.00 |
| D5670 | replace all teeth and acrylic on cast metal framework (maxillary) | $890.00 | $787.00 |
| D5671 | replace all teeth and acrylic on cast metal framework (mandibular) | $901.00 | $797.00 |
| D5710 | rebase complete maxillary denture | $692.00 | $612.00 |
| D5711 | rebase complete mandibular denture | $686.00 | $607.00 |
| D5720 | rebase maxillary partial denture | $668.00 | $591.00 |
| D5721 | rebase mandibular partial denture | $668.00 | $591.00 |
| D5730 | reline complete maxillary denture (chairside) | $441.00 | $391.00 |
| D5731 | reline complete mandibular denture (chairside) | $440.00 | $390.00 |
| D5740 | reline maxillary partial denture (chairside) | $432.00 | $383.00 |
| D5741 | reline mandibular partial denture (chairside) | $440.00 | $390.00 |
| D5750 | reline complete maxillary denture (laboratory) | $565.00 | $500.00 |
| D5751 | reline complete mandibular denture (laboratory) | $566.00 | $501.00 |
| D5760 | reline maxillary partial denture (laboratory) | $560.00 | $496.00 |
| D5761 | reline mandibular partial denture (laboratory) | $560.00 | $496.00 |
| D5810 | interim complete denture (maxillary) | $1,029.00 | $910.00 |
| D5811 | interim complete denture (mandibular) | $1,043.00 | $922.00 |
| D5820 | interim partial denture (maxillary) | $834.00 | $738.00 |
| D5821 | interim partial denture (mandibular) | $834.00 | $738.00 |
| D5850 | tissue conditioning, maxillary | $249.00 | $220.00 |
| D5851 | tissue conditioning, mandibular | $249.00 | $220.00 |
| D5860 | overdenture - complete, by report | $2,537.00 | $2,244.00 |
| D5861 | overdenture - partial, by report | $2,477.00 | $2,191.00 |
| D5862 | precision attachment, by report | $849.00 | $751.00 |
| D5867 | replacement of replaceable part of semi-precision or precision attachment (male or female component) | $462.00 | $409.00 |
| D5875 | modification of removable prosthesis following implant surgery | $466.00 | $413.00 |
| D5937 | trismus appliance (not for TMD treatment) | $882.00 | $780.00 |
| D5951 | feeding aid | $1,031.00 | $912.00 |
| D5982 | surgical stent | $529.00 | $468.00 |
| D5988 | surgical splint | $902.00 | $799.00 |
D6: implant services and fixed prosthodontics
85 rows| CDT | Description | North | South |
|---|---|---|---|
| D6010 | surgical placement of implant body: endosteal implant | $2,377.00 | $2,103.00 |
| D6012 | surgical placement of interim implant body for transitional prosthesis: endosteal implant | $1,872.00 | $1,656.00 |
| D6040 | surgical placement: eposteal implant | $9,819.00 | $8,687.00 |
| D6050 | surgical placement: transosteal implant | $6,885.00 | $6,091.00 |
| D6053 | implant/abutment supported removable denture for completely edentulous arch | $3,386.00 | $2,995.00 |
| D6054 | implant/abutment supported removable denture for partially edentulous arch | $3,321.00 | $2,938.00 |
| D6055 | connecting bar - implant supported or abutment supported | $3,506.00 | $3,102.00 |
| D6056 | prefabricated abutment - includes placement | $962.00 | $851.00 |
| D6057 | custom abutment - includes placement | $1,132.00 | $1,002.00 |
| D6058 | abutment supported porcelain/ceramic crown | $1,727.00 | $1,528.00 |
| D6059 | abutment supported porcelain fused to metal crown (high noble metal) | $1,734.00 | $1,534.00 |
| D6060 | abutment supported porcelain fused to metal crown (predominantly base metal) | $1,626.00 | $1,438.00 |
| D6061 | abutment supported porcelain fused to metal crown (noble metal) | $1,622.00 | $1,435.00 |
| D6062 | abutment supported cast metal crown (high noble metal) | $1,698.00 | $1,502.00 |
| D6063 | abutment supported cast metal crown (predominantly base metal) | $1,586.00 | $1,403.00 |
| D6064 | abutment supported cast metal crown (noble metal) | $1,623.00 | $1,436.00 |
| D6065 | implant supported porcelain/ceramic crown | $1,824.00 | $1,613.00 |
| D6066 | implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) | $1,838.00 | $1,626.00 |
| D6067 | implant supported metal crown (titanium, titanium alloy, high noble metal) | $1,855.00 | $1,641.00 |
| D6068 | abutment supported retainer for porcelain/ceramic FPD | $1,731.00 | $1,531.00 |
| D6069 | abutment supported retainer for porcelain fused to metal FPD (high noble metal) | $1,729.00 | $1,529.00 |
| D6070 | abutment supported retainer for porcelain fused to metal FPD (predominantly base metal) | $1,641.00 | $1,452.00 |
| D6071 | abutment supported retainer for porcelain fused to metal FPD (noble metal) | $1,643.00 | $1,453.00 |
| D6072 | abutment supported retainer for cast metal FPD (high noble metal) | $1,741.00 | $1,540.00 |
| D6073 | abutment supported retainer for cast metal FPD (predominantly base metal) | $1,635.00 | $1,446.00 |
| D6074 | abutment supported retainer for cast metal FPD (noble metal) | $1,603.00 | $1,418.00 |
| D6075 | implant supported retainer for ceramic FPD | $1,813.00 | $1,604.00 |
| D6076 | implant supported retainer for porcelain fused to metal FPD (titanium, titanium alloy, or high noble metal) | $1,854.00 | $1,640.00 |
| D6077 | implant supported retainer for cast metal FPD (titanium, titanium alloy, or high noble metal) | $1,870.00 | $1,654.00 |
| D6078 | implant/abutment supported fixed denture for completely edentulous arch | $6,621.00 | $5,858.00 |
| D6079 | implant/abutment supported fixed denture for partially edentulous arch | $4,784.00 | $4,232.00 |
| D6080 | implant maintenance procedures, including removal of prosthesis, cleansing of prosthesis and abutments and reinsertion of prosthesis | $375.00 | $331.00 |
| D6090 | repair implant supported prosthesis, by report | $889.00 | $786.00 |
| D6091 | replacement of semi-precision or precision attachment (male or female component) of implant/abutment supported prosthesis, per attachment | $752.00 | $665.00 |
| D6092 | recement implant/abutment supported crown | $189.00 | $167.00 |
| D6093 | recement implant/abutment supported fixed partial denture | $216.00 | $191.00 |
| D6094 | abutment supported crown - (titanium) | $1,590.00 | $1,407.00 |
| D6095 | repair implant abutment, by report | $863.00 | $763.00 |
| D6100 | implant removal, by report | $904.00 | $800.00 |
| D6190 | radiographic/surgical implant index, by report | $509.00 | $451.00 |
| D6194 | abutment supported retainer crown for FPD - (titanium) | $1,721.00 | $1,522.00 |
| D6205 | pontic - indirect resin based composite | $1,156.00 | $1,023.00 |
| D6210 | pontic - cast high noble metal | $1,296.00 | $1,147.00 |
| D6211 | pontic - cast predominantly base metal | $1,201.00 | $1,063.00 |
| D6212 | pontic - cast noble metal | $1,233.00 | $1,091.00 |
| D6214 | pontic - titanium | $1,292.00 | $1,143.00 |
| D6240 | pontic - porcelain fused to high noble metal | $1,319.00 | $1,167.00 |
| D6241 | pontic - porcelain fused to predominantly base metal | $1,215.00 | $1,075.00 |
| D6242 | pontic - porcelain fused to noble metal | $1,245.00 | $1,102.00 |
| D6245 | pontic - porcelain/ceramic | $1,358.00 | $1,202.00 |
| D6250 | pontic - resin with high noble metal | $1,255.00 | $1,111.00 |
| D6251 | pontic - resin with predominantly base metal | $1,244.00 | $1,101.00 |
| D6252 | pontic - resin with noble metal | $1,228.00 | $1,087.00 |
| D6253 | provisional pontic | $910.00 | $805.00 |
| D6545 | retainer - cast metal for resin bonded fixed prosthesis | $1,019.00 | $901.00 |
| D6548 | retainer - porcelain/ceramic for resin bonded fixed prosthesis | $1,122.00 | $992.00 |
| D6710 | crown - indirect resin based composite | $1,192.00 | $1,055.00 |
| D6720 | crown - resin with high noble metal | $1,253.00 | $1,109.00 |
| D6721 | crown - resin with predominantly base metal | $1,242.00 | $1,099.00 |
| D6722 | crown - resin with noble metal | $1,245.00 | $1,102.00 |
| D6740 | crown - porcelain/ceramic | $1,364.00 | $1,207.00 |
| D6750 | crown - porcelain fused to high noble metal | $1,330.00 | $1,177.00 |
| D6751 | crown - porcelain fused to predominantly base metal | $1,217.00 | $1,077.00 |
| D6752 | crown - porcelain fused to noble metal | $1,245.00 | $1,102.00 |
| D6780 | crown - 3/4 cast high noble metal | $1,271.00 | $1,125.00 |
| D6781 | crown - 3/4 cast predominantly base metal | $1,218.00 | $1,078.00 |
| D6782 | crown - 3/4 cast noble metal | $1,245.00 | $1,102.00 |
| D6783 | crown - 3/4 porcelain/ceramic | $1,296.00 | $1,147.00 |
| D6790 | crown - full cast high noble metal | $1,298.00 | $1,149.00 |
| D6791 | crown - full cast predominantly base metal | $1,201.00 | $1,063.00 |
| D6792 | crown - full cast noble metal | $1,233.00 | $1,091.00 |
| D6793 | provisional retainer crown | $661.00 | $585.00 |
| D6794 | crown - titanium | $1,250.00 | $1,106.00 |
| D6920 | connector bar | $1,182.00 | $1,046.00 |
| D6930 | recement fixed partial denture | $205.00 | $181.00 |
| D6940 | stress breaker | $528.00 | $467.00 |
| D6950 | precision attachment | $789.00 | $698.00 |
| D6970 | post and core in addition to fixed partial denture retainer, indirectly fabricated | $517.00 | $458.00 |
| D6972 | prefabricated post and core in addition to fixed partial denture retainer | $406.00 | $360.00 |
| D6973 | core build up for retainer, including any pins | $323.00 | $285.00 |
| D6975 | coping - metal | $832.00 | $736.00 |
| D6976 | each additional indirectly fabricated post - same tooth | $343.00 | $303.00 |
| D6977 | each additional prefabricated post - same tooth | $246.00 | $217.00 |
| D6980 | fixed partial denture repair, by report | $455.00 | $403.00 |
| D6985 | pediatric partial denture, fixed | $1,073.00 | $949.00 |
D7: oral and maxillofacial surgery
42 rows| CDT | Description | North | South |
|---|---|---|---|
| D7110 | single tooth (extraction) | n/a | n/a |
| D7111 | extraction, coronal remnants - deciduous tooth | $161.00 | $142.00 |
| D7120 | each add tooth (extraction) | n/a | n/a |
| D7140 | extraction, erupted tooth or exposed root (elevation and/or forceps removal) | $209.00 | $185.00 |
| D7210 | surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated | $328.00 | $290.00 |
| D7250 | surgical removal of residual tooth roots (cutting procedure) | $370.00 | $327.00 |
| D7290 | surgical repositioning of teeth | $625.00 | $553.00 |
| D7560 | maxillary sinusotomy for removal of tooth fragment or foreign body | $1,681.00 | $1,487.00 |
| D7610 | maxilla - open reduction (teeth immobilized, if present) | $5,162.00 | $4,567.00 |
| D7620 | maxilla - closed reduction (teeth immobilized, if present) | $4,180.00 | $3,699.00 |
| D7630 | mandible - open reduction (teeth immobilized, if present) | $5,349.00 | $4,732.00 |
| D7640 | mandible - closed reduction (teeth immobilized, if present) | $4,157.00 | $3,678.00 |
| D7650 | malar and/or zygomatic arch - open reduction | $4,631.00 | $4,097.00 |
| D7660 | malar and/or zygomatic arch - closed reduction | $3,862.00 | $3,417.00 |
| D7670 | alveolus closed reduction may include stabilization of teeth | $2,257.00 | $1,997.00 |
| D7671 | alveolus, open reduction may include stabilization of teeth | $1,512.00 | $1,338.00 |
| D7680 | facial bones - complicated reduction with fixation and multiple surgical approaches | $7,759.00 | $6,864.00 |
| D7710 | maxilla open reduction | $5,260.00 | $4,654.00 |
| D7720 | maxilla - closed reduction | $4,133.00 | $3,656.00 |
| D7730 | mandible - open reduction | $5,746.00 | $5,084.00 |
| D7740 | mandible - closed reduction | $4,273.00 | $3,781.00 |
| D7750 | malar and/or zygomatic arch - open reduction | $5,014.00 | $4,436.00 |
| D7760 | malar and/or zygomatic arch - closed reduction | $7,186.00 | $6,358.00 |
| D7770 | alveolus - open reduction stabilization of teeth | $3,294.00 | $2,914.00 |
| D7771 | alveolus, closed reduction stabilization of teeth | $2,287.00 | $2,023.00 |
| D7780 | facial bones - complicated reduction with fixation and multiple surgical approaches | $10,128.00 | $8,960.00 |
| D7810 | open reduction of dislocation | $5,014.00 | $4,436.00 |
| D7820 | closed reduction of dislocation | $763.00 | $675.00 |
| D7830 | manipulation under anesthesia | $1,166.00 | $1,032.00 |
| D7840 | condylectomy | $6,424.00 | $5,684.00 |
| D7850 | surgical discectomy, with/without implant | $6,210.00 | $5,494.00 |
| D7852 | disc repair | $6,609.00 | $5,847.00 |
| D7854 | synovectomy | $6,140.00 | $5,432.00 |
| D7856 | myotomy | $4,188.00 | $3,706.00 |
| D7880 | occlusal orthotic device, by report | $1,453.00 | $1,376.00 |
| D7910 | suture of recent small wounds up to 5 cm | $368.00 | $325.00 |
| D7911 | complicated suture - up to 5 cm | $610.00 | $540.00 |
| D7912 | complicated suture - greater than 5 cm | $961.00 | $850.00 |
| D7920 | skin graft (identify defect covered, location and type of graft) | $3,110.00 | $2,751.00 |
| D7955 | repair of maxillofacial soft and/or hard tissue defect | $4,554.00 | $3,941.00 |
| D7960 | frenulectomy - also known as frenectomy or frenotomy - separate procedure not incidental to another procedure | $538.00 | $476.00 |
| D7990 | emergency tracheotomy | $1,715.00 | $1,517.00 |
D8: orthodontics
5 rows| CDT | Description | North | South |
|---|---|---|---|
| D8210 | removable appliance therapy | $1,034.00 | $914.00 |
| D8220 | fixed appliance therapy | $1,174.00 | $1,039.00 |
| D8691 | repair of orthodontic appliance | $255.00 | $225.00 |
| D8692 | replacement of lost or broken retainer | $405.00 | $359.00 |
| D8693 | rebonding or recementing; and/or repair, as required, of fixed retainers | $408.00 | $361.00 |
D9: adjunctive general services
22 rows| CDT | Description | North | South |
|---|---|---|---|
| D9110 | palliative (emergency) treatment of dental pain - minor procedure | $154.00 | $136.00 |
| D9210 | local anesthesia not in conjunction with operative or surgical procedures | $91.00 | $80.00 |
| D9211 | regional block anesthesia | $113.00 | $100.00 |
| D9212 | trigeminal division block anesthesia | $317.00 | $280.00 |
| D9215 | local anesthesia in conjunction with operative or surgical procedures | $79.00 | $70.00 |
| D9220 | deep sedation/general anesthesia - first 30 minutes | $480.00 | $425.00 |
| D9221 | deep sedation/general anesthesia - each additional 15 minutes | $205.00 | $181.00 |
| D9230 | inhalation of nitrous oxide / anxiolysis, analgesia | $96.00 | $85.00 |
| D9241 | intravenous conscious sedation/analgesia - first 30 minutes | $509.00 | $451.00 |
| D9242 | intravenous conscious sedation/analgesia - each additional 15 minutes | $200.00 | $177.00 |
| D9248 | non-intravenous conscious sedation | $400.00 | $354.00 |
| D9310 | consultation - diagnostic service provided by dentist or physician other than requesting dentist or physician | $158.00 | $140.00 |
| D9410 | house/extended care facility call | $301.00 | $266.00 |
| D9420 | hospital or ambulatory surgical center call | $357.00 | $315.00 |
| D9430 | office visit for observation (during regularly scheduled hours) - no other services performed | $94.00 | $83.00 |
| D9610 | therapeutic parenteral drug, single administration | $131.00 | $116.00 |
| D9612 | therapeutic parenteral drugs, two or more administrations, different medications | $226.00 | $200.00 |
| D9630 | other drugs and/or medicaments, by report | $63.00 | $56.00 |
| D9940 | occlusal guard, by report | $727.00 | $643.00 |
| D9950 | occlusion analysis - mounted case | $418.00 | $370.00 |
| D9951 | occlusal adjustment - limited | $223.00 | $197.00 |
| D9952 | occlusal adjustment - complete | $846.00 | $748.00 |
Source
- The schedule: N.J.A.C. 11:3-29 Appendix, Exhibit 2, published by the New Jersey Department of Banking and Insurance and effective for treatment rendered on or after January 4, 2013. It has not been amended since.
- Official files: the Department’s auto medical fee schedule page, the rule text and the Department’s own FAQ.
- This page: parsed from the Department’s Excel file, with every row count and every figure cross-checked against the Department’s PDF of the same exhibit. Free to download as one CSV of all seven exhibits, 7,553 rows, no sign-up.
Amounts are the maximum reimbursable under the New Jersey PIP fee schedule, not what a provider billed and not what an insurer paid. N.J.A.C. 11:3-29caps reimbursement at the lesser of the provider’s charge or the scheduled amount, and 11:3-29.6 bars a provider from billing a patient the difference. This page reproduces the schedule; it does not decide whether a service was medically necessary, correctly coded, or covered. Verify any figure against the Department’s own file before relying on it. Current Dental Terminology (CDT) is copyright 2010 American Dental Association. All rights reserved. The dental descriptions shown are the short descriptors the State of New Jersey published in Exhibit 2.
Reading exhibit 2002
What the rule says about this schedule
What does Exhibit 2 cover?
The ten CDT categories, from diagnostic through adjunctive general services. The largest blocks are implant and fixed prosthodontic services with 85 codes, restorative with 75, removable prosthodontics with 45 and oral and maxillofacial surgery with 42. Orthodontics is the smallest at five.
The schedule prices the treatment, not the cause. Nothing on Exhibit 2 decides whether a particular crown or extraction was necessitated by the accident, which is a medical necessity question under 11:3-29.2 and 11:3-4, answered separately from the fee.
Why are two dental codes printed n/a?
D7110 and D7120, the old simple extraction codes, carry the letters n/a in both fee columns. That is what the State printed, and it is deliberate: CDT superseded both, and their replacement sits two rows below them on the same page. D7140, extraction of an erupted tooth or exposed root, is $209 in the North and $185 in the South.
The distinction matters when reading this page against a bill. An n/a cell is the schedule saying there is no fee for this code. An empty cell elsewhere on the seven exhibits means something different in each column, and neither is the same as a code being absent from the schedule entirely, which 11:3-29.4(e) prices as a usual and customary claim.
Does the $105 daily maximum apply to a dentist?
Yes, and the rule says so in those words. 11:3-29.4(m) states that the daily maximum applies to all providers, including dentists. The $105 ceiling on the Exhibit 6 physical medicine and rehabilitation codes is not limited to physical therapists, chiropractors or physicians.
It applies to the codes on Exhibit 6, not to dental treatment generally, so an extraction priced on this page is unaffected. Where a dental practice bills one of the 48 codes on Exhibit 6 on the same day another provider billed one, both fall inside the same $105.
Which region prices a dental bill?
The region where the treatment was given. 11:3-29.4(b) picks the fee by where the service was rendered, and 11:3-29.3(a) names Exhibit 2 among the schedules those regions govern. A patient's home address does not choose the column.
The one case where residence does decide is elective care outside New Jersey. 11:3-29.4(d)2 prices an elective out-of-state service under the schedule for the region where the insured lives. Where the out-of-state care was an emergency or medically necessary rather than elective, 29.4(d)1 uses the usual and customary fee for that provider's own location instead.
The other exhibits003
The rest of the New Jersey PIP fee schedule
Exhibit 1