Page 97

Effective Date:

Approval Date: 97

D5913 Nasal Prosthesis D5914 Auricular Prosthesis D5915 Orbital Prosthesis D5916 Ocular Prosthesis D5919 Facial Prosthesis D5922 Nasal Septal Prosthesis D5923 Ocular Prosthesis (interim) D5924 Cranial Prosthesis D5925 Facial Augmentation implant D5926 Nasal Prosthesis (replacement) D5927 Auricular Prosthesis (replacement) D5928 Orbital Prosthesis (replacement) D5929 Facial Prosthesis (replacement) D5931 Obturator Prosthesis (surgical) D5932 Obturator Prosthesis (definitive) D5933 Obturator Prosthesis (modification) D5934 Mandibular resection Prosthesis w/guide flange D5935 Mandibular resection Prosthesis w/out guide flange D5936 Obturator Prosthesis (interim) D5937 Trismus Appliance D5951 Feeding Aid D5952 Speech Aid prosthesis (pediatric) D5953 Speech Aid prosthesis (adult) D5954 Palatal Augmentation Prosthesis D5955 Palatal Lift Prosthesis (definitive) D5958 Palatal Lift Prosthesis (interim) D5959 Palatal Lift Prosthesis (modification) D5960 Speech Aid Prosthesis (modification) D5982 Surgical Stent D5983 Radiation Carrier D5984 Radiation Shield D5985 Radiation Cone locator D5987 Commissure Splint D5988 Surgical Splint D7285 Biopsy of oral tissue (hard) D7286 Biopsy of oral tissue (soft) D7410 Lesion up to 1.25 (benign) D7411 Lesion greater than 1.25 (benign) D7412 Complicated lesion (benign) D7413 Lesion up to 1.25 (malignant) D7414 Lesion greater than 1.25 (malignant) D7415 Complicated lesion (malignant) D7440 Lesion diameter up to 1.25 (malignant) D7441 Lesion diameter greater than 1.25 (malignant) D7460 Removal of Benign lesion up to 1.25 D7461 Removal of Benign lesion greater than 1.25 D7465 Destruction of lesion (by report) D7490 Radical resection upper/lower