IHS RVU table 2004
Document Sample
Indian Health Service RVU Table, 2004
Legend:
A - CDT-4/ADA developed code
R - RVSI developed code
X - Established Value
I - Interim Value
BR - By Report
RNE - Relativity not yet established, treat as "By Report"
CDT-4 INDIC
CODE ATOR DESCRIPTION
D0120 A ORAL EVALUATION, PERIODIC
D0140 A LIMITED ORAL EVALUATION - PROBLEM FOCUSED
D0150 A COMPREHENSIVE ORAL EVALUATION
D0160 A EXTENSIVE ORAL EVAL-PROBLEM FOCUSED
RE-EVALUATION - LIMITED, PROBLEM FOCUSED (ESTABLISHED PATIENT; NOT POST-
D0170 A OPERATIVE VISIT)
D0180 A COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT
D0210 A INTRAORAL COMPLETE SERIES
D0220 A INTRAORAL PERIAPICAL, SINGLE FILM
D0230 A INTRAORAL PERIAPICAL, ADDITIONAL FILM
D0240 A INTRAORAL OCCLUSAL FILM
D0250 A EXTRAORAL - FIRST FILM
D0260 A EXTRAORAL - EACH ADDITIONAL FILM
D0270 A BITEWINGS, SINGLE FILM
D0272 A BITEWINGS - TWO FILMS
D0274 A BITEWINGS, FOUR FILMS
D0277 A VERTICAL BITEWINGS - 7 TO 8 FILMS
D0290 A POSTERIOR-ANTERIOR OR LATERAL SKULL AND FACIAL BONE SURVEY FILM
D0310 A SIALOGRAPHY
D0320 A TEMPOROMANDIBULAR JOINT ARTHROGRAM, INCLUDING INJECTION
D0321 A OTHER TEMPOROMANDIBULAR JOINT FILMS, BY REPORT
D0322 A TOMOGRAPHIC SURVEY
D0330 A PANORAMIC-MAXILLA AND MANDIBLE FILM
D0340 A CEPHALOMETRIC FILM
D0350 A ORAL/FACIAL IMAGES (INCLUDES INTRA AND EXTRAORAL IMAGES)
D0415 A BACTERIOLOGIC STUDIES FOR PATHOLOGIC AGENTS
D0425 A CARIES SUSCEPTIBILITY TESTS
D0430 R BIOPSY AND EXAM OF ORAL TISSUE, HARD
D0460 A PULP VITALITY TESTS (PER VISIT)
D0470 A DIAGNOSTIC CASTS (PER SET)
ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF
D0472 A WRITTEN REPORT
ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, PREPARATION AND
D0473 A TRANSMISSION OF WRITTEN REPORT
ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, INCLUDING ASSESSMENT
OF SURGICAL MARGINS FOR PRESENCE OF DISEASE, PREPARATION AND TRANSMISSION OF
D0474 A WRITTEN REPORT
PROCESSING AND INTERPRETATION OF CYTOLOGIC SMEARS, INCLUDING THE PREPARATION
D0480 A AND TRANSMISSION OF WRITTEN REPORT
D0502 A OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT
D0999 A UNSPECIFIED DIAGNOSTIC PROCEDURE, BY REPORT
D1110 A ADULT PROPHYLAXIS, (PERMANENT DENTITION)
D1120 A PROPHYLAXIS - CHILD
D1201 A TOPICAL FLUORIDE WITH PROPHY CHILD
D1203 A TOPICAL FLUORIDE W/O PROPHY-CHILD
D1204 A TOPICAL FLUORIDE W/O PROPHY-ADULT
D1205 A TOPICAL APPLICATION OF FLUORIDE (INCLUDING PROPHYLAXIS) - ADULT
D1310 A NUTRITIONAL COUNSELING FOR ORAL HEALTH
D1320 A TOBACCO USE INTERVENTION TO PREVENT DISEASE
D1330 A PREVENTIVE PLAN AND INSTRUCTION
D1351 A SEALANT - PER TOOTH
D1370 R GROUP ORAL HEALTH COUNSELING (PER 15
D1510 A SPACE MAINTAINER - FIXED - UNILATERAL
D1515 A SPACE MAINTAINER - FIXED - BILATERAL
D1520 A SPACE MAINTAINER - REMOVABLE - UNILATERAL
D1525 A SPACE MAINTAINER - REMOVABLE - BILATERAL
D1550 A RE-CEMENTATION OF SPACE MAINTAINER
D2140 A AMALGAM - ONE SURFACE, PERMANENT
D2150 A AMALGAM - TWO SURFACES, PERMANENT
D2160 A AMALGAM - THREE SURFACES, PERMANENT
D2161 A AMALGAM - FOUR OR MORE SURFACES, PERMANENT
D2330 A RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIO
D2331 A RESIN-BASED COMPOSITE - TWO SURFACES, ANTERI
D2332 A RESIN-BASED COMPOSITE - THREE SURFACES, ANTE
D2335 A RESIN-BASED COMPOSITE - FOUR OR MORE SURFACE
D2390 A RESIN-BASED COMPOSITE CROWN, ANTERIOR
D2391 A RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR
D2392 A RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR
D2393 A RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR
D2394 A RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR
D2410 A GOLD FOIL - ONE SURFACE
D2420 A GOLD FOIL - TWO SURFACES
D2430 A GOLD FOIL - THREE SURFACES
D2510 A INLAY - METALLIC - ONE SURFACE
D2520 A INLAY - METALLIC - TWO SURFACES
D2530 A INLAY - METALLIC - THREE OR MORE SURFACES
D2542 A ONLAY - METALLIC-TWO SURFACES
D2543 A ONLAY - METALLIC-THREE SURFACES
D2544 A ONLAY - METALLIC-FOUR OR MORE SURFACES
D2610 A INLAY - PORCELAIN/CERAMIC - ONE SURFACE
D2620 A INLAY - PORCELAIN/CERAMIC - TWO SURFACES
D2630 A INLAY - PORCELAIN/CERAMIC - THREE OR MORE SURFACES
D2642 A ONLAY - PORCELAIN/CERAMIC - TWO SURFACES
D2643 A ONLAY - PORCELAIN/CERAMIC - THREE SURFACES
D2644 A ONLAY - PORCELAIN/CERAMIC - FOUR OR MORE SURFACES
D2650 A INLAY - RESIN-BASED COMPOSITE - ONE SURFACE
D2651 A INLAY - RESIN-BASED COMPOSITE - TWO SURFACES
D2652 A INLAY - RESIN-BASED COMPOSITE - THREE OR MORE SURFACES
D2662 A ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES
D2663 A ONLAY - RESIN-BASED COMPOSITE - THREE SURFACES
D2664 A ONLAY - - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES
D2710 A CROWN - RESIN (INDIRECT)
D2720 A CROWN - RESIN WITH HIGH NOBLE METAL
D2721 A CROWN - RESIN WITH PREDOMINANTLY BASE METAL
D2722 A CROWN - RESIN WITH NOBLE METAL
D2740 A CROWN - PORCELAIN/CERAMIC SUBSTRATE
D2750 A CROWN-PORCELAIN WITH GOLD
D2751 A CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL
D2752 A CROWN - PORCELAIN FUSED TO NOBLE METAL
D2780 A CROWN - 3/4 CAST HIGH NOBLE METAL
D2781 A CROWN - 3/4 CAST PREDOMINANTLY BASE METAL
D2782 A CROWN - 3/4 CAST NOBLE METAL
D2783 A CROWN - 3/4 PORCELAIN/CERAMIC
D2790 A CROWN-GOLD (FULL CAST)
D2791 A CROWN - FULL CAST PREDOMINANTLY BASE METAL
D2792 A CROWN - FULL CAST NOBLE METAL
D2799 A PROVISIONAL CROWN
D2910 A RECEMENT INLAY
D2920 A RECEMENT CROWNS
D2930 A CROWN-STAINLESS STEEL, PRIMARY TOOTH
D2931 A CROWN-STAINLESS STEEL, PERMANENT TOOTH
D2932 A PREFABRICATED RESIN CROWN
D2933 A PREFABRICATED STAINLESS STEEL CROWN WITH RESIN WINDOW
D2940 A SEDATIVE FILLING
D2950 A CORE BUILDUP, INCLUDING ANY PINS
D2951 A PIN RETENTION - PER TOOTH, IN ADDITION TO RESTORATION
D2952 A CAST POST AND CORE IN ADDITION TO CROWN
D2953 A EACH ADDITIONAL CAST POST - SAME TOOTH
D2954 A POST AND CORE (PREFAB.), EXCLUDING CROWN
D2955 A POST REMOVAL (NOT IN CONJUNCTION WITH ENDODONTIC THERAPY)
D2957 A EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH
D2960 A LABIAL VENEER (RESIN LAMINATE) - CHAIRSIDE
D2961 A LABIAL VENEER (RESIN LAMINATE) - LABORATORY
D2962 A LABIAL VENEER (PORCELAIN LAMINATE) - LABORATORY
D2970 A TEMPORARY RESTORATION (FRACTURED TOOTH)
D2980 A CROWN REPAIR, BY REPORT
D2999 A UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT
D3110 A PULP CAP DIRECT
D3120 A PULP CAP - INDIRECT (EXCLUDING FINAL RESTORATION)
D3220 A THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTO
D3221 A GROSS PULPAL DEBRIDEMENT, PRIMARY AND PERMAN
PULPAL THERAPY (RESORBABLE FILLING) - ANTERIOR, PRIMARY TOOTH (EXCLUDING FINAL
D3230 A RESTORATION)
D3240 A PULPAL THERAPY, POSTERIOR PRIMARY TOOTH
D3310 A ENDODONTIC FILL, ANTERIOR
D3320 A ENDODONTIC FILL, BICUSPID
D3330 A ENDODONTIC FILL, MOLAR
D3331 A TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS
D3332 A INCOMPLETE ENDODONTIC THERAPY; INOPERABLE OR FRACTURED TOOTH
D3333 A INTERNAL ROOT REPAIR OF PERFORATION DEFECTS
D3346 A RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - ANTERIOR
D3347 A RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - BICUSPID
D3348 A RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - MOLAR
APEXIFICATION/RECALCIFICATION - INITIAL VISIT (APICAL CLOSURE/CALCIFIC REPAIR OF
D3351 A PERFORATIONS, ROOT RESORPTION, ETC.)
APEXIFICATION/RECALCIFICATION - INTERIM MEDICATION REPLACEMENT (APICAL
D3352 A CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.)
APEXIFICATION/RECALCIFICATION - FINAL VISIT (INCLUDES COMPLETED ROOT CANAL
D3353 A THERAPY - APICAL CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.)
D3410 A APICOECTOMY/PERIRADICULAR SURGERY - ANTERIOR
D3421 A APICOECTOMY/PERIRADICULAR SURGERY - BICUSPID (FIRST ROOT)
D3425 A APICOECTOMY/PERIRADICULAR SURGERY - MOLAR (FIRST ROOT)
D3426 A APICOECTOMY/PERIRADICULAR SURGERY (EACH ADDITIONAL ROOT)
D3430 A RETROGRADE FILLING - PER ROOT
D3450 A ROOT AMPUTATION - PER ROOT
D3460 A ENDODONTIC ENDOSSEOUS IMPLANT
D3470 A INTENTIONAL REIMPLANTATION (INCLUDING NECESSARY SPLINTING)
D3910 A SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM
D3920 A HEMISECTION (INCLUDING ANY ROOT REMOVAL), NOT INCLUDING ROOT CANAL THERAPY
D3950 A CANAL PREPARATION AND FITTING OF PREFORMED DOWEL OR POST
D3999 A UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT
GINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED
D4210 A TEETH SPACES PER QUADRANT
D4211 A GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE TEETH, PER QUADRANT
D4240 A GINGIVAL FLAP PROC W/ ROOT PLANING (QUAD)
GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE TEETH, PER
D4241 A QUADRANT
D4245 A APICALLY POSITIONED FLAP
D4249 A CLINICAL CROWN LENGTHENING - HARD TISSUE
D4260 A OSSEOUS SURGERY, PER QUAD.
OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - ONE TO THREE TEETH, PER
D4261 A QUADRANT
D4263 A BONE REPLACEMENT GRAFT - FIRST SITE IN QUADRANT
D4264 A BONE REPLACEMENT GRAFT - EACH ADDITIONAL SITE IN QUADRANT
D4265 A BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION
D4266 A GUIDED TISSUE REGENERATION - RESORBABLE BARRIER, PER SITE
GUIDED TISSUE REGENERATION - NONRESORBABLE BARRIER, PER SITE (INCLUDES
D4267 A MEMBRANE REMOVAL)
D4268 A SURGICAL REVISION PROCEDURE, PER TOOTH
D4270 A PEDICLE SOFT TISSUE GRAFT PROCEDURE
D4271 A FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING DONOR SITE SURGERY)
D4273 A SUBEPITHELIAL CONNECTIVE TISSUE GRAFT PROCEDURES
DISTAL OR PROXIMAL WEDGE PROCEDURE (WHEN NOT PERFORMED IN CONJUNCTION WITH
D4274 A SURGICAL PROCEDURES IN THE SAME ANATOMICAL AREA)
D4275 A SOFT TISSUE ALLOGRAFT
D4276 A COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT
D4320 A PROVISIONAL SPLINTING - INTRACORONAL
D4321 A PROVISIONAL SPLINTING - EXTRACORONAL
D4341 A PERIODONTAL SCALING AND ROOT PLANING, PER QU
D4342 A PERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT
D4355 A FULL MOUTH DEBRIDEMENT FOR PERIO EVALUATION
D4381 A CONTROLLED RELEASE OF CHEMO AGENT (BY SITE)
D4910 A PERIODONTAL MAINTENANCE PROCEDURES (FOLLOWIN
D4920 A UNSCHEDULED DRESSING CHANGE (BY SOMEONE OTHER THAN TREATING DENTIST)
D4999 A UNSPECIFIED PERIODONTAL PROCEDURE, BY REPORT
D5110 A DENTURE - COMPLETE UPPER
D5120 A DENTURE - COMPLETE LOWER
D5130 A IMMEDIATE DENTURE - MAXILLARY
D5140 A IMMEDIATE DENTURE - MANDIBULAR
D5211 A MAXILLARY PARTIAL DENTURE - RESIN BASE (INCL
MANDIBULAR PARTIAL DENTURE - RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS,
D5212 A RESTS AND TEETH)
D5213 A UPPER PARTIAL, CAST FRAME, RESIN BASE
D5214 A LOWER PARTIAL, CAST FRAME, RESIN BASE
REMOVABLE UNILATERAL PARTIAL DENTURE - ONE PIECE CAST METAL (INCLUDING CLASPS
D5281 A AND TEETH)
D5410 A ADJUST FULL DENTURE, UPPER
D5411 A ADJUST FULL DENTURE, LOWER
D5421 A ADJUST PARTIAL DENTURE, UPPER
D5422 A ADJUST PARTIAL DENTURE - MANDIBULAR
D5510 A REPAIR BROKEN COMPLETE DENTURE BASE
D5520 A REPLACE MISSING/BROKEN TEETH (PER TOOTH)
D5610 A REPAIR RESIN DENTURE BASE
D5620 A REPAIR CAST FRAMEWORK
D5630 A REPAIR OR REPLACE BROKEN CLASP
D5640 A REPLACE BROKEN TEETH - PER TOOTH
D5650 A ADD TOOTH TO EXISTING PARTIAL DENTURE
D5660 A ADD CLASP TO EXISTING PARTIAL DENTURE
D5670 A REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MAXILLARY)
D5671 A REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MANDIBULAR)
D5710 A REBASE COMPLETE MAXILLARY DENTURE
D5711 A REBASE COMPLETE MANDIBULAR DENTURE
D5720 A REBASE MAXILLARY PARTIAL DENTURE
D5721 A REBASE MANDIBULAR PARTIAL DENTURE
D5730 A RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)
D5731 A RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)
D5740 A RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE)
D5741 A RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE)
D5750 A RELINE COMPLETE MAXILLARY DENTURE (LABORATORY)
D5751 A RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY)
D5760 A RELINE MAXILLARY PARTIAL DENTURE (LABORATORY)
D5761 A RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY)
D5810 A INTERIM COMPLETE DENTURE (MAXILLARY)
D5811 A INTERIM COMPLETE DENTURE (MANDIBULAR)
D5820 A INTERIM PARTIAL DENTURE (MAXILLARY)
D5821 A INTERIM PARTIAL DENTURE (MANDIBULAR)
D5850 A TISSUE CONDITIONING, MAXILLARY
D5851 A TISSUE CONDITIONING, MANDIBULAR
D5860 A OVERDENTURE - COMPLETE, BY REPORT
D5861 A OVERDENTURE - PARTIAL, BY REPORT
D5862 A PRECISION ATTACHMENT, BY REPORT
REPLACEMENT OF REPLACEABLE PART OF SEMI-PRECISION OR PRECISION ATTACHMENT
D5867 A (MALE OR FEMALE COMPONENT)
D5875 A MODIFICATION OF REMOVABLE PROSTHESIS FOLLOWING IMPLANT SURGERY
D5899 A UNSPECIFIED REMOVABLE PROSTHODONTIC PROCEDURE, BY REPORT
D5911 A FACIAL MOULAGE (SECTIONAL)
D5912 A FACIAL MOULAGE (COMPLETE)
D5913 A NASAL PROSTHESIS
D5914 A AURICULAR PROSTHESIS
D5915 A ORBITAL PROSTHESIS
D5916 A OCULAR PROSTHESIS
D5919 A FACIAL PROSTHESIS
D5922 A NASAL SEPTAL PROSTHESIS
D5923 A OCULAR PROSTHESIS, INTERIM
D5924 A CRANIAL PROSTHESIS
D5925 A FACIAL AUGMENTATION IMPLANT PROSTHESIS
D5926 A NASAL PROSTHESIS, REPLACEMENT
D5927 A AURICULAR PROSTHESIS, REPLACEMENT
D5928 A ORBITAL PROSTHESIS, REPLACEMENT
D5929 A FACIAL PROSTHESIS, REPLACEMENT
D5931 A OBTURATOR PROSTHESIS, SURGICAL
D5932 A OBTURATOR PROSTHESIS, DEFINITIVE
D5933 A OBTURATOR PROSTHESIS, MODIFICATION
D5934 A MANDIBULAR RESECTION PROSTHESIS WITH GUIDE FLANGE
D5935 A MANDIBULAR RESECTION PROSTHESIS WITHOUT GUIDE FLANGE
D5936 A OBTURATOR PROSTHESIS, INTERIM
D5937 A TRISMUS APPLIANCE (NOT FOR TMD TREATMENT)
D5951 A FEEDING AID
D5952 A SPEECH AID PROSTHESIS, PEDIATRIC
D5953 A SPEECH AID PROSTHESIS, ADULT
D5954 A PALATAL AUGMENTATION PROSTHESIS
D5955 A PALATAL LIFT PROSTHESIS, DEFINITIVE
D5958 A PALATAL LIFT PROSTHESIS, INTERIM
D5959 A PALATAL LIFT PROSTHESIS, MODIFICATION
D5960 A SPEECH AID PROSTHESIS, MODIFICATION
D5982 A SURGICAL STENT
D5983 A RADIATION CARRIER
D5984 A RADIATION SHIELD
D5985 A RADIATION CONE LOCATOR
D5986 A FLUORIDE GEL CARRIER
D5987 A COMMISSURE SPLINT
D5988 A SURGICAL SPLINT
D5999 A UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT
D6010 A SURGICAL PLACEMENT OF IMPLANT BODY: ENDOSTEAL IMPLANT
D6020 A ABUTMENT PLACEMENT OR SUBSTITUTION: ENDOSTEAL IMPLANT
D6040 A SURGICAL PLACEMENT: EPOSTEAL IMPLANT
D6050 A SURGICAL PLACEMENT: TRANSOSTEAL IMPLANT
IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR COMPLETELY EDENTULOUS
D6053 A ARCH
D6054 A IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH
D6055 A DENTAL IMPLANT SUPPORTED CONNECTING BAR
D6056 A PREFABRICATED ABUTMENT
D6057 A CUSTOM ABUTMENT
D6058 A ABUTMENT SUPPORTED PORCELAIN/CERAMIC CROWN
D6059 A ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (HIGH NOBLE METAL)
ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (PREDOMINANTLY BASE
D6060 A METAL)
D6061 A ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (NOBLE METAL)
D6062 A ABUTMENT SUPPORTED CAST METAL CROWN (HIGH NOBLE METAL)
D6063 A ABUTMENT SUPPORTED CAST METAL CROWN (PREDOMINANTLY BASE METAL)
D6064 A ABUTMENT SUPPORTED CAST METAL CROWN (NOBLE METAL)
D6065 A IMPLANT SUPPORTED PORCELAIN/CERAMIC CROWN
IMPLANT SUPPORTED PORCELAIN FUSED TO METAL CROWN (TITANIUM, TITANIUM ALLOY, HIGH
D6066 A NOBLE METAL)
D6067 A IMPLANT SUPPORTED METAL CROWN (TITANIUM, TITANIUM ALLOY, HIGH NOBLE METAL)
D6068 A ABUTMENT SUPPORTED RETAINER FOR PORCELAIN/CERAMIC FPD
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (HIGH NOBLE
D6069 A METAL)
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (PREDOMINANTLY
D6070 A BASE METAL)
D6071 A ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (NOBLE METAL)
D6072 A ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (HIGH NOBLE METAL)
D6073 A ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (PREDOMINANTLY BASE METAL)
D6074 A ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (NOBLE METAL)
D6075 A IMPLANT SUPPORTED RETAINER FOR CERAMIC FPD
IMPLANT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (TITANIUM, TITANIUM
D6076 A ALLOY, OR HIGH NOBLE METAL)
IMPLANT SUPPORTED RETAINER FOR CAST METAL FPD (TITANIUM, TITANIUM ALLOY, OR HIGH
D6077 A NOBLE METAL)
D6078 A IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR COMPLETELY EDENTULOUS ARCH
D6079 A IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENTULOUS ARCH
IMPLANT MAINTENANCE PROCEDURES, INCLUDING REMOVAL OF PROSTHESIS, CLEANSING OF
D6080 A PROSTHESIS AND ABUTMENTS AND REINSERTION OF PROSTHESIS
D6090 A REPAIR IMPLANT SUPPORTED PROSTHESIS, BY REPORT
D6095 A REPAIR IMPLANT ABUTMENT, BY REPORT
D6100 A IMPLANT REMOVAL, BY REPORT
D6199 A UNSPECIFIED IMPLANT PROCEDURE, BY REPORT
D6210 A PONTIC - CAST HIGH NOBLE METAL
D6211 A PONTIC - CAST PREDOMINANTLY BASE METAL
D6212 A PONTIC - CAST NOBLE METAL
D6220 R SLOTTED FACING
D6240 A PONTIC - PORCELAIN FUSED TO HIGH NOBLE METAL
D6241 A PONTIC - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL
D6242 A PONTIC - PORCELAIN FUSED TO NOBLE METAL
D6245 A PONTIC - PORCELAIN/CERAMIC
D6250 A PONTIC - RESIN WITH HIGH NOBLE METAL
D6251 A PONTIC - RESIN WITH PREDOMINANTLY BASE METAL
D6252 A PONTIC - RESIN WITH NOBLE METAL
D6253 A PROVISIONAL PONTIC
D6545 A RETAINER - CAST METAL FOR RESIN BONDED FIXED PROSTHESIS
D6548 A RETAINER - PORCELAIN/CERAMIC FOR RESIN BONDED FIXED PROSTHESIS
D6600 A INLAY - PORCELAIN/CERAMIC, TWO SURFACES
D6601 A INLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
D6602 A INLAY - CAST HIGH NOBLE METAL, TWO SURFACES"
D6603 A INLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES
D6604 A INLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES
D6605 A INLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES
D6606 A INLAY - CAST NOBLE METAL, TWO SURFACES
D6607 A INLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
D6608 A ONLAY -PORCELAIN/CERAMIC, TWO SURFACES
D6609 A ONLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
D6610 A ONLAY - CAST HIGH NOBLE METAL, TWO SURFACES
D6611 A ONLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES
D6612 A ONLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES
D6613 A ONLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES
D6614 A ONLAY - CAST NOBLE METAL, TWO SURFACES
D6615 A ONLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
D6720 A CROWN - RESIN WITH HIGH NOBLE METAL
D6721 A CROWN - RESIN WITH PREDOMINANTLY BASE METAL
D6722 A CROWN - RESIN WITH NOBLE METAL
D6740 A CROWN - PORCELAIN/CERAMIC
D6750 A CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL
D6751 A CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL
D6752 A CROWN - PORCELAIN FUSED TO NOBLE METAL
D6780 A CROWN - 3/4 CAST HIGH NOBLE METAL
D6781 A CROWN - 3/4 CAST PREDOMINANTLY BASE METAL
D6782 A CROWN - 3/4 CAST NOBLE METAL
D6783 A CROWN - 3/4 PORCELAIN/CERAMIC
D6790 A CROWN - FULL CAST HIGH NOBLE METAL
D6791 A CROWN - FULL CAST PREDOMINANTLY BASE METAL
D6792 A CROWN - FULL CAST NOBLE METAL
D6793 A PROVISIONAL RETAINER CROWN
D6920 A CONNECTOR BAR
D6930 A RECEMENT BRIDGE
D6940 A STRESS BREAKER
D6950 A PRECISION ATTACHMENT
D6970 A CAST POST AND CORE IN ADDITION TO FIXED PARTIAL DENTURE RETAINER
D6971 A CAST POST AS PART OF FIXED PARTIAL DENTURE RETAINER
D6972 A PREFABRICATED POST AND CORE IN ADDITION TO FIXED PARTIAL DENTURE RETAINER
D6973 A CORE BUILD UP FOR RETAINER, INCLUDING ANY PINS
D6975 A COPING - METAL
D6976 A EACH ADDITIONAL CAST POST - SAME TOOTH
D6977 A EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH
D6980 A FIXED PARTIAL DENTURE REPAIR, BY REPORT
D6985 A PEDIATRIC PARTIAL DENTURE, FIXED
D6999 A UNSPECIFIED FIXED PROSTHODONTIC PROCEDURE, BY REPORT
D7111 A CORONAL REMNANTS - DECIDUOUS TOOTH
D7140 A EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL)
D7210 A SURGICAL EXTRACTION OF ERUPTED TOOTH
D7220 A SURGICAL EXTRACTION, SOFT TISSUE IMPACTION
D7230 A REMOVAL OF IMPACTED TOOTH - PARTIALLY BONY
D7240 A REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY
REMOVAL OF IMPACTED TOOTH - COMPLETELY BONY, WITH UNUSUAL SURGICAL
D7241 A COMPLICATIONS
D7250 A SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)
D7260 A OROANTRAL FISTULA CLOSURE
D7261 A PRIMARY CLOSURE OF A SINUS PERFORATION
TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED
D7270 A TOOTH
TOOTH TRANSPLANTATION (INCLUDES REIMPLANTATION FROM ONE SITE TO ANOTHER AND
D7272 A SPLINTING AND/OR STABILIZATION)
D7280 A SURGICAL ACCESS OF AN UNERUPTED TOOTH
D7281 A SURGICAL EXPOSURE OF IMPACTED OR UNERUPTED TOOTH TO AID ERUPTION
D7282 A MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION
D7285 A BIOPSY OF ORAL TISSUE - HARD (BONE, TOOTH)
D7286 A BIOPSY OF ORAL TISSUE - SOFT (ALL OTHERS)
D7287 A CYTOLOGY SAMPLE COLLECTION
D7290 A SURGICAL REPOSITIONING OF TEETH
D7291 A TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, BY REPORT
D7310 A ALVEOLOPLASTY WITH EXTRACTIONS
D7320 A ALVEOLOPLASTY WITHOUT EXTRACTIONS
D7340 A VESTIBULOPLASTY - RIDGE EXTENSION (SECONDARY EPITHELIALIZATION)
VESTIBULOPLASTY - RIDGE EXTENSION (INCLUDING SOFT TISSUE GRAFTS, MUSCLE
REATTACHMENT, REVISION OF SOFT TISSUE ATTACHMENT AND MANAGEMENT OF
D7350 A HYPERTROPHIED AND HYPERPLASTIC TISSUE)
D7410 A EXCISION OF BENIGN LESION UP TO 1.25 CM
D7411 A EXCISION OF BENIGN LESION GREATER THAN 1.25 CM
D7412 A EXCISION OF BENIGN LESION, COMPLICATED
D7413 A EXCISION OF MALIGNANT LESION UP TO 1.25 CM
D7414 A EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM
D7415 A EXCISION OF MALIGNANT LESION, COMPLICATED
D7440 A EXCISION OF MALIGNANT TUMOR - LESION DIAMETER UP TO 1.25 CM
D7441 A EXCISION OF MALIGNANT TUMOR - LESION DIAMETER GREATER THAN 1.25 CM
D7450 A REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM
REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER THAN
D7451 A 1.25 CM
D7460 A REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR - LESION DIAMETER UP TO 1.25 CM
REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR - LESION DIAMETER GREATER
D7461 A THAN 1.25 CM
D7465 A DESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL METHOD, BY REPORT
D7471 A REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE)
D7472 A REMOVAL OF TORUS PALATINUS
D7473 A REMOVAL OF TORUS MANDIBULARIS
D7485 A SURGICAL REDUCTION OF OSSEOUS TUBEROSITY
D7490 A RADICAL RESECTION OF MANDIBLE WITH BONE GRAFT
D7510 A INCISION AND DRAINAGE OF ABSCESS/INTRAORAL
D7520 A INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE
D7530 A REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE
D7540 A REMOVAL OF REACTION PRODUCING FOREIGN BODIES, MUSCULOSKELETAL SYSTEM
D7550 A PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE
D7560 A MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT OR FOREIGN BODY
D7610 A MAXILLA - OPEN REDUCTION (TEETH IMMOBILIZED, IF PRESENT)
D7620 A MAXILLA - CLOSED REDUCTION (TEETH IMMOBILIZED, IF PRESENT)
D7630 A MANDIBLE - OPEN REDUCTION (TEETH IMMOBILIZED, IF PRESENT)
D7640 A MANDIBLE - CLOSED REDUCTION (TEETH IMMOBILIZED, IF PRESENT)
D7650 A MALAR AND/OR ZYGOMATIC ARCH - OPEN REDUCTION
D7660 A MALAR AND/OR ZYGOMATIC ARCH - CLOSED REDUCTION
D7670 A ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
D7671 A ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
FACIAL BONES - COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL
D7680 A APPROACHES
D7710 A MAXILLA - OPEN REDUCTION
D7720 A MAXILLA - CLOSED REDUCTION
D7730 A MANDIBLE - OPEN REDUCTION
D7740 A MANDIBLE - CLOSED REDUCTION
D7750 A MALAR AND/OR ZYGOMATIC ARCH - OPEN REDUCTION
D7760 A MALAR AND/OR ZYGOMATIC ARCH - CLOSED REDUCTION
D7770 A ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH
D7771 A ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH
FACIAL BONES - COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL
D7780 A APPROACHES
D7810 A OPEN REDUCTION OF DISLOCATION
D7820 A CLOSED REDUCTION OF DISLOCATION
D7830 A MANIPULATION UNDER ANESTHESIA
D7840 A CONDYLECTOMY
D7850 A SURGICAL DISCECTOMY, WITH/WITHOUT IMPLANT
D7852 A DISC REPAIR
D7854 A SYNOVECTOMY
D7856 A MYOTOMY
D7858 A JOINT RECONSTRUCTION
D7860 A ARTHROTOMY
D7865 A ARTHROPLASTY
D7870 A ARTHROCENTESIS
D7871 A NON-ARTHROSCOPIC LYSIS AND LAVAGE
D7872 A ARTHROSCOPY - DIAGNOSIS, WITH OR WITHOUT BIOPSY
D7873 A ARTHROSCOPY - SURGICAL: LAVAGE AND LYSIS OF ADHESIONS
D7874 A ARTHROSCOPY - SURGICAL: DISC REPOSITIONING AND STABILIZATION
D7875 A ARTHROSCOPY - SURGICAL: SYNOVECTOMY
D7876 A ARTHROSCOPY - SURGICAL: DISCECTOMY
D7877 A ARTHROSCOPY - SURGICAL: DEBRIDEMENT
D7880 A OCCLUSAL ORTHOTIC DEVICE, BY REPORT"
D7899 A UNSPECIFIED TMD THERAPY, BY REPORT"
D7910 A SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM
D7911 A COMPLICATED SUTURE - UP TO 5 CM
D7912 A COMPLICATED SUTURE - GREATER THAN 5 CM
D7920 A SKIN GRAFT (IDENTIFY DEFECT COVERED, LOCATION AND TYPE OF GRAFT)
D7940 A OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES
D7941 A OSTEOTOMY - MANDIBULAR RAMI
D7943 A OSTEOTOMY - MANDIBULAR RAMI WITH BONE GRAFT; INCLUDES OBTAINING THE GRAFT
D7944 A OSTEOTOMY - SEGMENTED OR SUBAPICAL – PER SEXTANT OR QUADRANT
D7945 A OSTEOTOMY - BODY OF MANDIBLE
D7946 A LEFORT I (MAXILLA - TOTAL)
D7947 A LEFORT I (MAXILLA - SEGMENTED)
LEFORT II OR LEFORT III (OSTEOPLASTY OF FACIAL BONES FOR MIDFACE HYPOPLASIA OR
D7948 A RETRUSION)-WITHOUT BONE GRAFT
D7949 A LEFORT II OR LEFORT III - WITH BONE GRAFT
OSSEOUS, OSTEOPERIOSTEAL, OR CARTILAGE GRAFT OF THE MANDIBLE OR FACIAL BONES -
D7950 A AUTOGENOUS OR NONAUTOGENOUS, BY REPORT"
D7955 A REPAIR OF MAXILLOFACIAL SOFT AND HARD TISSUE DEFECT
D7960 A FRENULECTOMY (FRENECTOMY OR FRENOTOMY) - SEPARATE PROCEDURE
D7970 A EXCISION OF HYPERPLASTIC TISSUE - PER ARCH
D7971 A EXCISION OF PERICORONAL GINGIVA
D7972 A SURGICAL REDUCTION OF FIBROUS TUBEROSITY
D7980 A SIALOLITHOTOMY
D7981 A EXCISION OF SALIVARY GLAND, BY REPORT
D7982 A SIALODOCHOPLASTY
D7983 A CLOSURE OF SALIVARY FISTULA
D7990 A EMERGENCY TRACHEOTOMY
D7991 A CORONOIDECTOMY
D7995 A SYNTHETIC GRAFT - MANDIBLE OR FACIAL BONES, BY REPORT
IMPLANT-MANDIBLE FOR AUGMENTATION PURPOSES (EXCLUDING ALVEOLAR RIDGE), BY
D7996 A REPORT
APPLIANCE REMOVAL (NOT BY DENTIST WHO PLACED APPLIANCE), INCLUDES REMOVAL OF
D7997 A ARCHBAR
D7999 A UNSPECIFIED ORAL SURGERY PROCEDURE, BY REPORT
D8010 A LIMITED ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION
D8020 A LIMITED ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION
D8030 A LIMITED ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION
D8040 A LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION
D8050 A INTERCEPTIVE ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION
D8060 A INTERCEPTIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION
D8070 A COMPREHENSIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION
D8080 A COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION
D8090 A COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION
D8210 A REMOVABLE APPLIANCE THERAPY
D8220 A FIXED APPLIANCE THERAPY
D8660 A PRE-ORTHODONTIC TX VISIT
D8670 A PERIODIC ORTHODONTIC TREATMENT VISIT
ORTHODONTIC RETENTION (REMOVAL OF APPLIANCES, CONSTRUCTION AND PLACEMENT OF
D8680 A RETAINER(S))
D8690 A ORTHODONTIC TREATMENT (ALTERNATIVE BILLING TO A CONTRACT FEE)
D8691 A REPAIR OF ORTHODONTIC APPLIANCE
D8692 A REPLACEMENT OF LOST OR BROKEN RETAINER
D8999 A UNSPECIFIED ORTHODONTIC PROCEDURE, BY REPORT
D9110 A EMERGENCY TX DENTAL PAIN (PALLIATIVE)
D9210 A LOCAL ANESTHESIA NOT IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES
D9211 A REGIONAL BLOCK ANESTHESIA
D9212 A TRIGEMINAL DIVISION BLOCK
D9215 A LOCAL ANESTHESIA
D9220 A GENERAL ANESTHESIA
D9221 A DEEP SEDATION/GENERAL ANESTHESIA - EACH ADDITIONAL 15 MINUTES
D9230 A ANALGESIA, ANXIOLYSIS, INHALATION OF NITROUS
D9241 A INTRAVENOUS SEDATION/ANALGESIA - FIRST 30 MI
D9242 A INTRAVENOUS SEDATION/ANALGESIA - EACH ADDITI
D9248 A NON-INTRAVENOUS CONSCIOUS SEDATION
D9310 A CONSULTATION BY DENTIST OR MD (PER SESSION)
D9410 A HOUSE/EXTENDED CARE FACILITY CALL
D9420 A HOSPITAL CALL
D9430 A OFFICE VISIT, OBSERVATION ONLY
D9440 A OFFICE VISIT - AFTER REGULARLY SCHEDULED HOURS
D9450 A CASE PRESENTATION, DETAILED AND EXTENSIVE TREATMENT PLANNING
D9610 A THERAPEUTIC DRUG INJECTION
D9630 A OTHER DRUGS AND/OR MEDICAMENTS, BY REPORT
D9910 A APPLICATION OF DESENSITIZING MEDICAMENT
D9911 A APPLICATION OF DESENSITIZING RESIN FOR CERVICAL AND/OR ROOT SURFACE, PER TOOTH
D9920 A BEHAVIOR MANAGEMENT (BY REPORT)
D9930 A COMPLICATIONS (POSTSURGICAL)
D9940 A OCCLUSAL GUARD (BY REPORT)
D9941 A FABRICATION OF ATHLETIC MOUTHGUARD
D9950 A OCCLUSION ANALYSIS - MOUNTED CASE
D9951 A OCCLUSAL ADJUSTMENT - LIMITED
D9952 A OCCLUSAL ADJUSTMENT - COMPLETE
D9970 A ENAMEL MICROABRASION
D9971 A ODONTOPLASTY 1 - 2 TEETH; INCLUDES REMOVAL OF ENAMEL PROJECTIONS
D9972 A EXTERNAL BLEACHING - PER ARCH
D9973 A EXTERNAL BLEACHING - PER TOOTH
D9974 A INTERNAL BLEACHING - PER TOOTH
D9999 A UNSPECIFIED ADJUNCTIVE PROCEDURE, BY REPORT
Legend:
A - CDT/ADA developed code
R - RVSI developed code
X - Established Value
I - Interim Value
BR - By Report
RNE - Relativity not yet established, treat as "By Report"
I= Interim Value
BR = By Report
RNE = Relativity Not Yet
IHS
Final Flag
RVU Value
0.70 X
0.92 X
1.00 X
2.27 I
1.00 I
1.12 I
1.95 X
0.45 X
0.23 X
0.54 X
1.12 X
0.78 X
0.46 X
0.67 X
0.91 X
1.34 X
2.01 X
4.69 X
11.17 X
3.46 I
6.25 X
1.44 I
1.39 X
1.12 X
1.55 I
1.45 X
3.57 X
0.76 X
1.25 X
1.67 I
0.00 RNE
0.00 RNE
0.00 RNE
3.01 I
0.30 BR
1.99 X
1.02 X
1.58 X
0.56 X
0.56 X
2.23 X
1.43 X
0.69 I
1.03 X
0.80 X
0.84 X
4.47 X
6.70 X
5.58 X
7.82 X
1.34 X
2.00 X
2.20 X
2.70 X
3.30 X
2.00 X
3.00 X
3.50 X
4.00 X
3.13 I
2.34 I
3.01 I
3.46 I
3.80 I
8.93 X
10.61 X
13.18 X
12.73 X
14.40 X
13.40 X
16.53 I
17.31 X
18.98 X
13.96 X
14.52 X
18.98 X
15.63 X
17.87 X
20.66 X
12.84 I
14.52 X
18.98 X
14.52 X
17.87 X
18.98 X
11.17 X
22.33 X
16.75 X
18.98 X
22.33 X
14.96 X
17.87 X
20.10 X
20.10 I
14.52 I
16.75 I
21.22 I
13.36 X
15.63 X
17.87 X
11.17 I
1.67 X
1.43 X
4.00 X
2.26 X
5.36 X
5.02 X
1.43 X
3.54 X
1.12 X
8.93 X
7.26 I
4.05 X
4.47 I
3.91 I
6.70 X
11.17 X
16.08 X
3.85 X
4.58 I
0.53 BR
0.74 X
1.12 X
3.00 X
3.64 I
3.68 I
3.70 I
10.20 X
10.00 X
11.24 X
11.28 I
6.03 I
2.90 I
12.28 I
14.96 I
18.42 I
12.73 I
15.41 I
8.93 X
10.16 I
11.72 I
13.06 I
10.83 I
3.35 X
5.58 X
17.31 I
11.17 I
2.90 X
7.03 X
3.35 X
1.37 BR
10.61 X
9.16 I
7.54 X
3.46 I
14.40 I
11.39 I
10.63 X
8.93 I
10.61 I
8.71 I
5.25 I
15.52 I
17.87 I
14.85 I
13.62 X
14.07 X
18.42 I
11.39 I
9.71 I
10.61 I
7.59 X
6.70 X
4.55 X
3.01 I
2.71 I
2.38 I
3.29 X
1.45 X
1.00 BR
17.96 X
18.06 X
30.71 X
30.71 X
13.40 X
19.76 X
20.28 X
20.18 X
14.96 X
1.21 X
1.21 X
1.20 X
1.34 X
3.35 X
1.92 X
3.35 X
4.58 X
4.13 X
3.35 X
3.35 X
5.58 X
16.64 I
16.64 I
11.17 X
11.17 X
8.93 X
8.93 X
6.70 X
6.70 X
5.58 X
5.58 X
8.93 X
8.93 X
8.93 X
8.93 X
13.40 X
13.40 X
11.17 X
11.17 X
2.52 X
2.90 X
29.59 I
30.15 I
9.94 I
4.24 X
5.47 I
1.00 BR
4.47 X
6.70 X
111.66 X
111.66 X
150.74 X
156.32 X
156.32 BR
72.58 I
89.33 I
156.32 RNE
156.32 RNE
55.83 X
55.83 X
75.37 X
75.37 RNE
35.73 X
83.75 X
16.75 X
83.75 X
83.75 X
30.71 I
55.83 RNE
33.50 X
33.50 X
33.50 X
75.37 BR
72.58 X
42.43 I
13.40 I
8.93 I
6.03 X
55.83 BR
55.83 BR
31.26 X
3.35 X
55.83 RNE
11.95 I
55.83 BR
36.85 I
17.31 I
164.14 I
106.08 I
4.47 I
3.35 I
41.87 X
14.40 I
16.53 I
21.33 I
22.78 I
15.74 I
20.66 I
19.88 I
19.54 I
20.55 I
27.92 I
27.92 I
27.92 I
19.88 I
19.54 I
17.53 I
17.75 I
19.88 I
18.87 I
19.09 I
22.56 I
21.89 I
24.34 I
55.83 I
48.13 I
3.91 I
12.51 I
13.51 I
14.40 I
21.89 BR
22.33 X
15.63 X
17.87 X
4.47 X
24.57 X
20.10 X
22.33 X
16.86 I
22.33 X
15.63 X
20.10 X
2.79 I
10.61 I
15.30 I
8.49 I
9.04 I
9.38 I
11.05 I
6.03 I
7.70 I
7.59 I
8.26 I
9.27 I
9.71 I
11.05 I
11.84 I
7.70 I
8.49 I
8.26 I
8.82 I
22.33 X
16.75 X
18.98 X
17.87 I
26.80 X
17.87 X
22.33 X
21.22 X
17.42 I
17.53 I
17.64 I
21.22 X
15.63 X
18.98 X
1.67 I
14.96 I
1.92 X
5.58 X
8.93 X
8.93 X
6.25 X
6.70 X
4.58 I
11.72 I
4.80 I
2.57 I
5.81 I
1.50 RNE
3.83 BR
2.23 I
2.46 I
3.72 X
4.60 X
6.00 X
7.20 X
11.17 X
4.47 X
13.40 X
13.40 RNE
8.04 X
11.17 X
6.70 X
4.47 X
2.23 I
5.81 X
4.00 X
0.17 RNE
7.26 X
4.24 X
4.20 X
5.30 X
13.40 X
31.26 X
5.58 X
5.47 I
7.59 I
11.17 I
9.83 I
15.86 I
8.82 X
17.87 X
7.59 X
9.83 X
7.48 X
10.61 X
5.86 X
9.49 I
7.82 I
8.04 I
8.82 I
138.46 I
2.48 X
6.70 X
4.69 I
9.49 X
7.82 X
14.52 X
64.76 X
53.60 X
73.70 X
44.66 X
70.35 X
42.43 X
22.33 X
42.43 I
106.08 X
77.05 X
49.13 X
85.98 X
50.25 X
72.58 X
67.00 X
42.43 X
4.02 I
136.23 I
70.35 X
21.77 I
10.16 X
96.03 X
91.56 X
109.43 I
111.66 RNE
111.66 RNE
125.06 I
33.50 X
93.79 I
4.47 X
43.88 I
29.03 I
31.82 I
40.20 I
42.99 I
44.66 I
41.31 I
15.86 I
4.47 BR
15.41 I
6.03 X
8.93 X
36.85 I
59.18 X
156.32 I
158.56 I
125.06 I
126.18 I
139.58 X
139.58 X
156.32 X
227.79 I
48.01 I
50.25 I
6.70 X
53.60 I
13.51 I
6.70 RNE
9.27 X
44.66 X
27.36 X
18.98 X
18.54 X
69.23 X
27.36 BR
27.36 BR
1.00 RNE
1.00 BR
24.57 I
29.03 I
39.08 I
37.96 I
36.85 I
41.31 I
101.61 X
101.61 X
106.08 X
13.29 X
15.97 X
3.23 I
1.85 I
9.38 I
37.07 I
3.63 I
5.69 I
2.50 BR
1.87 X
1.00 X
0.91 X
2.24 X
0.52 X
3.82 X
2.23 X
1.94 X
4.05 I
1.70 I
4.97 I
1.77 X
3.35 X
3.35 X
1.19 X
2.23 X
0.50 RNE
0.96 X
0.52 I
1.50 X
1.23 I
1.51 I
1.72 I
8.87 X
3.24 I
5.02 X
1.91 X
8.93 X
3.01 I
3.01 I
6.25 I
4.02 X
4.58 X
0.33 BR
I= Interim Value
BR = By Report
RNE = Relativity Not Yet
Established (treat as
By Report
