Preventive Services
(D1510-D1575): Clinical criteria for space maintenance
(D1354 & D1355) Clinical criteria for caries arresting and preventative medicaments
Restorative Services
(D2950, D2952-D2957): Clinical criteria for restorative substructures
(D2928-D2934): Clinical criteria for prefabricated crowns
(D2710-D2794): Clinical criteria for single crowns
(D2140-D2394): Clinical criteria for direct restorations
(D2991): Clinical criteria for hydroxyapatite regeneration
Endodontic Services
(D3310-D3333): Clinical criteria for endodontic therapy
Periodontal Services
(D4341-D4342): Clinical criteria for periodontal scaling and root planing
(D4910): Clinical criteria for periodontal maintenance
(D4210-D4212): Clinical criteria for gingivectomy
(D4240-D4241): Clinical criteria for the gingival flap procedure
(D4260-D4261): Clinical criteria for periodontal osseous surgery
(D4263-D4267): Clinical criteria for periodontal regenerative treatment
Removable Prosthodontic Services
(D5211-D5286): Clinical criteria for removable partial dentures
(D5110 – D5140, D5511 – D5520, D5710, D5711, D5730, D5731, D5750) Clinical criteria for complete dentures
Fixed Prosthodontic Services
(D6205-D6999): Clinical criteria for fixed partial dentures
Oral and Maxillofacial Services
(D7111-D7250): Clinical criteria for extraction of teeth
(D7310-D7321): Clinical criteria for alveoloplasty
(D7961-D7963): Clinical criteria for frenectomy
(D7251): Clinical criteria for coronectomy
Orthodontic Services
(D8010-D8090, D8210-D8670, D8680): Clinical criteria for orthodontic treatment
Adjunctive General Services
(D9222-D9223, D9239-D9243): Clinical criteria for anesthesia and intravenous sedation
(D9920) Clinical criteria for behavioral management
Other Criteria
(D0120-D9999)*: Clinical criteria for appropriateness of care
*These criteria apply to any dental procedure deemed to have been provided in a clinically inappropriate manner