Diagnostic Action Add. Nomenclature / Title (additions in blue underline; deletions in red strike-through)

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04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory #. CID DIA-04 Diagnostic Action Add Ms. Horton Clinical Oral Evaluations Treatment Planning After a comprehensive exam, radiographs, photos, models, research, patient input, and/or consultation with specialists or laboratory technicians a document is created that describes in detail all the findings, recommendations, and contingencies pertaining to the needs of the patient. This is time the practitioner spends after the patient has left. Typically it results in or more typewritten pages of findings, referrals, concerns and considerations for adult patients and their unique needs. This is not the PROGRESS NOTES. This is not the letters the dentist sends on the patient s behalf to specialists. This is the time given to determining what treatment should be performed. Yea 0 Accept Nay Decline X Abstain 0 Other The need for this action, to create a new subcategory of service, was rendered moot by the CMC decision to decline Inventory Item #, a new CDT Code for treatment planning

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory #. CID DIA-05 D0xxx Action Add Ms. Horton treatment planning involving extensive, complex, and contingent study of photos, images, models, progress notes, and requiring conferences with specialists or specialty laboratories in order to formulate an achievable and predictable result None Yea 0 Accept The Code Maintenance Committee believes that the procedure described in the submission reflects and may be reported with the following current CDT Code entry: Nay Decline X D9450 case presentation, detailed and extensive treatment planning Abstain 0 Other Established patient. Not performed on same day as evaluation.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory #. CID DIA-0 D0xxx Action Add Dr. Burns post treatment limited re-evaluation A re-evaluation of the function, comfort and stability of extensive or complicated treatment after a period of function. This may very well require evaluation of information acquired through additional diagnostic procedures; those procedures to be reported separately. Yea Nay 0 Accept Decline X The Code Maintenance Committee believes that the intent of this request is achieved by CMC acceptance of another action request, Inventory Item #4, that reads as follows: D0xxx re-evaluation post-operative office visit Abstain 0 Other <no descriptor>

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 4 OF 04 Inventory # 4. CID DIA-09 D0xxx Action Add CDBP re-evaluation post-operative office visit None Yea 5 Accept X Nay 4 Decline Abstain Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 5 OF 04 Inventory # 5. CID DIA-0 D0xxx Action Add AAOMR D photographic image of face with or without cranium Dimensionally accurate D extraoral image constructed by integration of multiple photographic images or laser scan. Yea Nay 0 Accept Decline X The Code Maintenance Committee believes that the intent of this request is achieved by CMC acceptance of two substitute action requests Inventory Item #7a that reads as follows: Abstain 0 Other D0xxx D photographic image This procedure is for dental or maxillofacial diagnostic purposes. Not applicable for a CAD-CAM procedure. Inventory Item #7b, that reads as follows: D050 D oral/facial photographic image obtained intra-orally or extra-orally

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 6 OF 04 Inventory # 6. CID DIA-0 D0xxx Action Add AAOMR D intraoral photographic image Dimensionally accurate D intraoral image constructed by integration of multiple photographic images or laser scan. Yea Nay 0 Accept Decline X The Code Maintenance Committee believes that the intent of this request is achieved by CMC acceptance of two substitute action requests Inventory Item #7a that reads as follows: Abstain 0 Other D0xxx D photographic image This procedure is for dental or maxillofacial diagnostic purposes. Not applicable for a CAD-CAM procedure. Inventory Item #7b, that reads as follows: D050 D oral/facial photographic image obtained intra-orally or extra-orally

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 7 OF 04 Inventory # 7. CID DIA-0 D0xxx Action Add AAOMR D photographic image of intraoral appliance or surgical stent Dimensionally accurate D image of intraoral appliance, surgical stent, or study model constructed by integration of multiple photographic images or laser scan. Yea Nay 0 Accept Decline X The Code Maintenance Committee believes that the intent of this request is achieved by CMC acceptance of two substitute action requests Inventory Item #7a that reads as follows: Abstain 0 Other D0xxx D photographic image This procedure is for dental or maxillofacial diagnostic purposes. Not applicable for a CAD-CAM procedure. Inventory Item #7b, that reads as follows: D050 D oral/facial photographic image obtained intra-orally or extra-orally 4

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 8 OF 04 Inventory # 7a CID DIA-A D0xxx Action Add CMC D photographic image This procedure is for dental or maxillofacial diagnostic purposes. Not applicable for a CAD-CAM procedure. Yea 9 Accept X Nay 0 Decline Abstain Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 9 OF 04 Inventory # 7b CID DIA-B D050 Action Revise CMC D oral/facial photographic image obtained intra-orally or extra-orally None Yea Accept X Nay 0 Decline Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 0 OF 04 Inventory # 8. CID DIA-06 D0xxx Action Add Dr. Bieri extraoral bitewing Digital radiograph taken extraorally by panoramic machine in place of internal bitewing. Yea 6 Accept Nay 5 Decline Abstain 0 Other X Motion to table and review by CMC Working Group to be created by the Chair, with a recommendation for the 05 CMC meeting.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory # 9. CID DIA-07 D0xxx Action Add CDBP extraoral image - unilateral None Yea 6 Accept Nay 5 Decline Abstain 0 Other X Motion to table and review by CMC Working Group to be created by the Chair, with a recommendation for the 05 CMC meeting.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory # 0. CID DIA-08 D0xxx Action Add CDBP extraoral image - bilateral None Yea 6 Accept Nay 5 Decline Abstain 0 Other X Motion to table and review by CMC Working Group to be created by the Chair, with a recommendation for the 05 CMC meeting.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory #. CID DIA- D050 Action Delete CDBP extraoral first radiographic image None Yea 6 Accept Nay 5 Decline Abstain 0 Other X Motion to table and review by CMC Working Group to be created by the Chair, with a recommendation for the 05 CMC meeting.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 4 OF 04 Inventory #. CID DIA- D060 Action Delete CDBP extraoral each additional radiographic image None Yea 6 Accept Nay 5 Decline Abstain 0 Other X Motion to table and review by CMC Working Group to be created by the Chair, with a recommendation for the 05 CMC meeting.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 5 OF 04 Inventory #. CID DIA- D00 Action Revise Dr. Dubowsky Intraoral - complete series of radiographic images A radiographic survey of the whole mouth, usually consisting of 4- periapical and posterior bitewing images intended to display the crowns and roots of all teeth, periapical areas and alveolar bone. Yea 5 Accept Nay 5 Decline Abstain Other X Motion to table and review by CMC Working Group to be created by the Chair, with a recommendation for the 05 CMC meeting.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 6 OF 04 Inventory # 4. CID PRE-0 D0 Action Revise Dr. Vernon prophylaxis-adult, light Removal of only a minimal amount of plaque, calculus, and stains from the tooth structure. Yea 0 Accept Nay Decline X Abstain 0 Other This request applies a level of difficulty to a current CDT Code procedure D0 prophylaxis, adult. The Code Maintenance Committee determined that the revision is not necessary as the level of difficulty or complexity for any given dental procedure is expected to vary.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 7 OF 04 Inventory # 5. CID PRE-0 Dxxx Action Add Dr. Vernon prophylaxis adult, medium Removal of a moderate amount of plaque, calculus and stains from the tooth structures. Yea 0 Accept Nay Decline X Abstain 0 Other This request applies a level of difficulty to a current CDT Code procedure D0 prophylaxis, adult. The Code Maintenance Committee determined that the addition is not necessary as the level of difficulty or complexity for any given dental procedure is expected to vary.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 8 OF 04 Inventory # 6. CID PRE-0 Dxxx Action Add Dr. Vernon prophylaxis adult, heavy Removal of a considerable amount of plaque, calculus and stains from the tooth structures. Yea 0 Accept Nay Decline X Abstain 0 Other This request applies a level of difficulty to a current CDT Code procedure D0 prophylaxis, adult. The Code Maintenance Committee determined that the addition is not necessary as the level of difficulty or complexity for any given dental procedure is expected to vary.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 9 OF 04 Inventory # 7. CID PRE-05 Dxxx Action Add AAPD sealant repair per tooth Reapplication of sealant material to a previously sealed tooth surface. 4 The CMC: ) declined a motion to amend the nomenclature by insertion of or replacement (i.e. sealant repair or replacement ); and ) accepted a motion to delete the entire descriptor as highlighted above. Yea 9 Accept X Nay 8 Decline Abstain 4 Other 5

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 0 OF 04 Inventory # 8. CID PRE-06 D06 Action Delete AAPD topical application of fluoride varnish None Yea 0 Accept Nay 0 Decline Abstain Other X The CMC accepted the submitter s (AAPD) request to withdraw this item from the agenda, and address a substitute inventory item 8a.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory # 8a CID None D08 Action Revise AAPD topical application of fluoride excluding varnish None Yea Accept X Nay 0 Decline Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory # 9. CID PRE-04 D555 Action Revise CDBP removal of fixed space maintainer Procedure delivered by dentist who did not originally place the appliance or by the practice where the appliance was originally delivered to the patient. Yea 4 Accept Nay 6 Decline X Abstain Other The Code Maintenance Committee believes that deletion of the descriptor would substantially change the nature of the procedure as described in the current CDT Code entry, and result in CDT Code selection confusion, or difficulty analyzing procedure usage based on coding.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory # 9a CID None D7997 Action Revise CMC appliance removal (not by dentist who placed appliance), includes removal of archbar None Yea 0 Accept Nay Decline X Abstain 0 Other The Code Maintenance Committee believes that revision of the nomenclature would substantially change the nature of the procedure as described in the current CDT Code entry.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 4 OF 04 Inventory # 9b CID None Dxxxx Action Add CMC appliance removal by dentist who placed appliance None Yea 0 Accept Nay Decline X Abstain 0 Other The Code Maintenance Committee believes that the procedure described in the proposed nomenclature reflects and may be reported with the current CDT Code entry applicable to appliance placement.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 5 OF 04 Inventory # 0. CID RES-0 Dxxx Action Add CDT Workgroup NADP atraumatic restorative treatment (ART) primary tooth Includes removal of demineralized tooth tissues, typically with hand instruments only, restoring the prepared cavity and sealing the adjacent pits and fissures with an adhesive filling material. This is intended to be a final restoration. Not to be used as an interim or temporary restoration. Vote Decision Rationale for Decline for Decline / Explanation of Other Yea Accept Nay 9 Decline X Abstain 0 Other The Code Maintenance Committee believes that the procedure described is adequately reported using the current suite of restorative codes, e.g., D40 D94.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 6 OF 04 Inventory #. CID RES-0 Dxxx Action Add Ms. Horton resin buccal or lingual CEJ restructuring This procedure eliminates significant notching at and below the cementoenamel junction to restore tooth form and function. Vote Decision Rationale for Decline for Decline / Explanation of Other Yea 0 Accept Nay Decline X Abstain 0 Other The Code Maintenance Committee believes that the procedure described is adequately reported using the current suite of restorative codes, e.g., D40 D94.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 7 OF 04 Inventory #. CID RES-0 Dxxx Action Add Dr. Barberi removal of crown to evaluate restorability Use in the event that a crown is removed to evaluate restorability and determined to be non-restorable. If restorable, treatment provided should be coded instead. Vote Decision Rationale for Decline for Decline / Explanation of Other Yea Accept Nay 9 Decline X Abstain 0 Other The Code Maintenance Committee believes that the procedure described is adequately reported using current CDT Code D999 unspecified restorative procedure, by report.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 8 OF 04 Inventory #. CID RES-04 Dxxx Action Add CDBP re-cement or re-bond veneer None Vote Decision Rationale for Decline for Decline / Explanation of Other Yea 0 Accept Nay 0 Decline X The CMC declined this request in favor of the D90 revision described in Inventory # a Abstain Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 9 OF 04 Inventory # a CID None D90 Action Revise CMC re-cement or re-bond inlay, onlay, veneer or partial coverage restoration None Vote Decision Rationale for Decline for Decline / Explanation of Other Yea 0 Accept X Nay 0 Decline Abstain Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 0 OF 04 Inventory # 4. CID RES-05 D975 Action Revise CDBP coping A thin covering of the remaining coronal portion of a tooth, usually fabricated of metal and devoid of anatomic contour,. This is to that can be used as a definitive restoration. Vote Decision Rationale for Decline for Decline / Explanation of Other Yea 9 Accept X Nay 8 Decline Abstain 4 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory # 5. CID RES- 06a D50 Action Revise DDPA inlay metallic one surface(s) An intracoronal dental restoration, made outside the oral cavity to conform to the prepared cavity, which restores some of the occlusal surface of a tooth, but does not restore any cusp tips. It is retained by luting cement. 4 5 6 7 NOTE: The action illustrated above would be applied to all Inlay CDT Codes D50 - D50: Inlay - metallic - X surface(s) D60 - D60: Inlay - porcelain/ceramic - X surface(s) D650 - D65: Inlay - resin-based composite - X surface(s) The action illustrated above is an alternative to Inventory Item 6 / RES-06b Vote Decision Rationale for Decline for Decline / Explanation of Other Yea 0 Accept Nay 0 Decline X Rendered moot by acceptance of Inventory # 8 Abstain Other 8

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory # 6. CID RES- 06b D000-D999 Restorative Action Revise DDPA Inlay/Onlay Restorations Inlay: An intracoronal dental restoration, made outside the oral cavity to conform to the prepared cavity, which restores some of the occlusal surface of a tooth, but does not restore any cusp tips. It is retained by luting cement. Onlay: A dental restoration made outside the oral cavity that covers one or more cusp tips and adjoining occlusal surfaces, but not the entire external surface. It is retained by luting cement. NOTE: The action illustrated above is an alternative to Inventory Item 5 / RES-06a, and mirrors Item 8 / RES-07b Vote Decision Rationale for Decline for Decline / Explanation of Other Yea Accept Nay Decline Abstain Other X Duplicates Inventory # 8. Rendered moot by acceptance of Inventory # 8 4

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE OF 04 Inventory # 7. CID RES- 07a D54 Action Revise DDPA onlay metallic one surface(s) A dental restoration made outside the oral cavity that covers one or more cusp tips and adjoining occlusal surfaces, but not the entire external surface. It is retained by luting cement. 4 5 6 7 NOTE: The action illustrated above would be applied to the following Onlay CDT Codes D54 - D54: Onlay - metallic - X surface(s) D64 - D64: Onlay - porcelain/ ceramic - X surface(s) D66 - D664: Onlay - resin-based composite - X surface(s) The action illustrated above is an alternative to Inventory Item 8 / RES-07b Vote Decision Rationale for Decline for Decline / Explanation of Other Yea 0 Accept Nay 0 Decline X Rendered moot by acceptance of Inventory # 8 Abstain Other 8

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 4 OF 04 Inventory # 8. CID RES- 07b D000-D999 Restorative Action Revise DDPA Inlay/Onlay Restorations Inlay: An intracoronal dental restoration, made outside the oral cavity to conform to the prepared cavity, which restores some of the occlusal surface of a tooth, but does not restore any cusp tips. It is retained by luting cement. Onlay: A dental restoration made outside the oral cavity that covers one or more cusp tips and adjoining occlusal surfaces, but not the entire external surface. It is retained by luting cement. 4 The CMC accepted motions to: ) amend both definitions by deletion of their closing sentences; and ) amend the inlay definition s first sentence. Both amendments are as highlighted above. Vote Decision Rationale for Decline for Decline / Explanation of Other Yea 0 Accept X Nay 0 Decline Abstain Other 5

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 5 OF 04 Inventory # 9. CID RES- 07c Inlay/Onlay Restorations Action Revise DDPA Not Applicable D544 onlay metallic four or more surfaces A dental restoration made outside the oral cavity that covers one or more cusp tips and adjoining occlusal surfaces, but not the entire external surface. It is retained by luting cement. Porcelain/ceramic inlays/onlays include all indirect ceramic and porcelain type inlays/onlays. D60 inlay porcelain/ceramic one surface Vote Decision Rationale for Decline for Decline / Explanation of Other Yea 0 Accept Nay 0 Decline X Rendered moot by acceptance of Inventory # 8 Abstain Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 6 OF 04 Inventory # 0. CID RES- 07d Inlay/Onlay Restorations Action Revise DDPA Not Applicable D644 onlay porcelain/ceramic four or more surfaces A dental restoration made outside the oral cavity that covers one or more cusp tips and adjoining occlusal surfaces, but not the entire external surface. It is retained by luting cement. Resin-based composite inlays/onlays must utilize indirect technique. D650 inlay resin-based composite one surface Vote Decision Rationale for Decline for Decline / Explanation of Other Yea 0 Accept Nay 0 Decline X Rendered moot by acceptance of Inventory # 8 Abstain Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 7 OF 04 Inventory #. CID RES-08 Dxxx Action Add Ms. Locke crown porcelain/zirconium None Vote Decision Rationale for Decline for Decline / Explanation of Other Yea 0 Accept Nay Decline X Abstain 0 Other The Code Maintenance Committee believes that current CDT Code D740 crown porcelain/ceramic substrate is appropriate to document and report delivery of a porcelain/zirconium crown.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 8 OF 04 Inventory #. CID PER-0 D4xxx Action Add Dr. Barish non-surgical periodontal services The submission contains the following response to question 5 Full text of requested Descriptor Yea 0 Accept Nay Decline X Abstain 0 Other The Code Maintenance Committee believes that the current CDT Code D455 full mouth debridement and others such as D490 periodontal maintenance and D0 prophylaxis, adult are appropriate to record and report the procedure described in the submission.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 9 OF 04 Inventory #. CID PER-05 D4xxx Action Add CDBP laser de-epithelialization, in conjunction with decontamination of the root surface and de-cortication of bony support None Yea Accept Nay 6 Decline X Abstain Other Lasers are being used in conjunction with other procedures. The CMC could not identify how this procedure differs from periodontal procedures reported with current codes, such as D44 periodontal scaling and root planing

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 40 OF 04 Inventory # 4. CID PER-0 D4xxx Action Add CDBP laser de-epithelialization, in conjunction with decontamination of the root surface and/or de-cortication of bony support to teeth per quadrant The de-epithelialization component of this procedure is delivered using a light amplification by stimulated emission of radiation (LASER) device. Other components of this procedure may involve different types of instruments to achieve the desired outcome. Yea 6 Accept Nay Decline X Abstain Other Lasers are being used in conjunction with other procedures. The CMC could not identify how this procedure differs from periodontal procedures reported with current codes, such as D44 periodontal scaling and root planing

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 4 OF 04 Inventory # 5. CID PER-04 D4xxx Action Add CDBP laser de-epithelialization, in conjunction with decontamination of the root surface and/or de-cortication of bony support 4 or more teeth per quadrant The de-epithelialization component of this procedure is delivered using a light amplification by stimulated emission of radiation (LASER) device. Other components of this procedure may involve different types of instruments to achieve the desired outcome. Yea 6 Accept Nay Decline X Abstain Other Lasers are being used in conjunction with other procedures. The CMC could not identify how this procedure differs from periodontal procedures reported with current codes, such as D44 periodontal scaling and root planing

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 4 OF 04 Inventory # 6. CID PER-0 D4xxx Action Add Dr. Kusek laser-assisted periodontal therapies This procedure involves thermal decontamination of diseased crevicular to reduce periodontal pocket depths. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature. Some soft tissue removal occurs. This procedure may be used as a definitive treatment in certain stages of periodontal disease, as a part of pre-surgical procedures in others, and/or as a part of periodontal maintenance. Yea Accept Nay 7 Decline X Abstain Other Lasers are being used in conjunction with other procedures. The CMC could not identify how this procedure differs from periodontal procedures reported with current codes, such as D490 periodontal maintenance.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 4 OF 04 Inventory # 7. CID PER-08 D4xxx Action Add Mr. Pickard bacterial decontamination This procedure involves the use of a soft tissue laser in aiding of the destruction of bacteria in the periodontal pocket. Yea 0 Accept Nay 0 Decline X Abstain Other Lasers are being used in conjunction with other procedures. The CMC could not identify how this procedure differs from periodontal procedures reported with current codes, such as D490 periodontal maintenance.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 44 OF 04 Inventory # 8. CID PER- D449 Action Revise AAP clinical crown lengthening hard tissue This procedure is employed to allow a restorative procedure or crown on a tooth with little or no tooth structure exposed to the oral cavity. Crown lengthening requires reflection of a full thickness flap and removal of bone, altering to alter the crown to root ratio. It is performed in a healthy periodontal environment, as opposed to osseous surgery, which is performed in the presence of periodontal disease. Where there are adjacent teeth, the flap design may involve a larger surgical area. The CMC accepted a motion to eliminate the last sentence from the current descriptor as highlighted above. Yea Accept X Nay 0 Decline Abstain 0 Other 4

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 45 OF 04 Inventory # 9. CID PER- D460 Action Revise AAP osseous surgery (including elevation of a full thickness flap and closure) four or more contiguous teeth or tooth bounded spaces per quadrant This procedure modifies the bony support of the teeth by reshaping the alveolar process to achieve a more physiologic form during the surgical procedure. This must include the removal of supporting bone (ostectomy) and/or non-supporting bone (osteoplasty). Other procedures may be required concurrent to D460 and should be reported using their own unique codes. Yea Accept X Nay 0 Decline Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 46 OF 04 Inventory # 40. CID PER-4 D46 Action Revise AAP osseous surgery (including elevation of a full thickness flap and closure) one to three contiguous teeth or tooth bounded spaces per quadrant This procedure modifies the bony support of the teeth by reshaping the alveolar process to achieve a more physiologic form during the surgical procedure. This must include the removal of supporting bone (ostectomy) and/or non-supporting bone (osteoplasty). Other procedures may be required concurrent to D460 and should be reported using their own unique codes. Yea Accept X Nay 0 Decline Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 47 OF 04 Inventory # 4. CID PER-06 D466 Action Revise DDPA guided tissue regeneration - resorbable barrier, per site This procedure does not include flap entry and closure, or, when indicated, wound debridement, osseous contouring, bone replacement grafts, and placement of biologic materials to aid in osseous regeneration. This procedure can be used for periodontal and peri-implant defects. Yea Accept Nay 0 Decline The CMC approved the motion to accept submitter s request to withdraw this submission. Abstain 0 Other X

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 48 OF 04 Inventory # 4. CID PER-07 D467 Action Revise DDPA guided tissue regeneration non-resorbable barrier, per site (includes membrane removal) This procedure does not include flap entry and closure, or, when indicated, wound debridement, osseous contouring, bone replacement grafts, and placement of biologic materials to aid in osseous regeneration. This procedure can be used for periodontal and peri-implant defects. Yea Accept Nay 0 Decline The CMC approved the motion to accept submitter s request to withdraw this submission. Abstain 0 Other X

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 49 OF 04 Inventory # 4. CID PER-5 D475 Action Revise AAP soft tissue allograft or collagen matrix graft Procedure is performed to create or augment the gingiva, with or without root coverage. This may be used to eliminate the pull of the frena and muscle attachments, to extend the vestibular fornix, or correct localized gingival recession. There is no donor site. Yea Accept Nay 0 Decline The CMC approved the motion to accept submitter s request to withdraw this submission. Abstain 0 Other X

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 50 OF 04 Inventory # 44. CID PER-0 D455 Action Revise Dr. Vernon full mouth debridement to enable comprehensive evaluation and diagnosis, can be performed the same day as the examination The gross removal of plaque and calculus that interfere with the ability of the dentist to perform a comprehensive oral evaluation. This preliminary procedure does not preclude the need for additional procedures. A thorough examination by the dentist can be performed on the same day as the full mouth debride. Yea 0 Accept Nay Decline X Abstain 0 Other The current CDT Code entry for D455 full mouth debridement does not preclude delivery of this service on the same day as an oral evaluation.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 5 OF 04 Inventory # 45. CID PER-7 D4xxx Action Add AGD localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, not including medicament, per site None Yea 0 Accept Nay 0 Decline The CMC approved the motion to accept submitter s request to withdraw this submission. Abstain Other X

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 5 OF 04 Inventory # 46. CID PER-8 D48 Action Revise AGD localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, including medicament, per tooth site, by report FDA approved subgingival delivery devices containing antimicrobial medication(s) are inserted into periodontal pockets to suppress the pathogenic microbiota. These devices slowly release the pharmacological agents so they can remain at the intended site of action in a therapeutic concentration for a sufficient length of time. Yea 0 Accept Nay 0 Decline The CMC approved the motion to accept submitter s request to withdraw this submission. Abstain Other X

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 5 OF 04 Inventory # 47. CID PER-09 D48 Action Revise Dr. Segelnick localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth per site FDA approved subgingival delivery devices containing antimicrobial medication(s) are inserted into periodontal pockets to suppress the pathogenic microbiota. These devices slowly release the pharmacological agents so they can remain at the intended site of action in a therapeutic concentration for a sufficient length of time. Yea 0 Accept Nay 9 Decline X Abstain Other The current ADA Dental Claim Form (paper) and the HIPAA standard electronic dental claim transaction (87Dv500) do not support reporting tooth site; only tooth number and surface are claim data elements.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 54 OF 04 Inventory # 48. CID PER-6 D48 Action Revise Ms. Locke localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth per site FDA approved subgingival delivery devices containing antimicrobial medication(s) are inserted into periodontal pockets to suppress the pathogenic microbiota. These devices slowly release the pharmacological agents so they can remain at the intended site of action in a therapeutic concentration for a sufficient length of time. Yea 0 Accept Nay 9 Decline X Abstain Other The current ADA Dental Claim Form (paper) and the HIPAA standard electronic dental claim transaction (87Dv500) do not support reporting tooth site; only tooth number and surface are claim data elements.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 55 OF 04 Inventory # 49. CID PER- D48 Action Revise Dr. Kusek non-surgical localized delivery of antimicrobial agents into via a controlled release vehicle into diseased crevicular tissue, per quadrant or, per tooth FDA approved subgingival delivery devices containing antimicrobial medication(s) are inserted into periodontal pockets to suppress the pathogenic microbiota. These devices slowly release the pharmacological agents so they can remain at the intended site of action in a therapeutic concentration for a sufficient length of time. Examples include pharmacological devices of lasers. Yea 0 Accept Nay 0 Decline X Abstain Other The treatment modality as described in the submission appears to be completely different from the procedure addressed in the current D48 nomenclature and descriptor.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 56 OF 04 Inventory # 50. CID PRR-0 D58xx Action Add Ms. Horton surgical guide for immediate denture service None Yea 0 Accept Nay 0 Decline X Abstain Other The Code Maintenance Committee found that the documentation provided with the submission did not provide an adequate information foundation on which to render a decision or amend the submission. Adequate information could include the reason why the surgical guide procedure would be separate from the immediate denture service.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 57 OF 04 Inventory # 5. CID PRR-0 D58xx Action Add CDBP cleaning and maintenance inspection of a removable appliance This procedure does not include any required adjustments. The CMC accepted a motion to amend the nomenclature as highlighted above. Yea 6 Accept X Nay 5 Decline Abstain 0 Other X The CMC vote to accept as amended included the recommendation that this addition be in the Adjunctive General Services category. 4

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 58 OF 04 Inventory # 5. CID IMP-0 D6xxx Action Add Dr. Williams radiographic/surgical implant index, guided and fully adjustable A fully adjustable guided appliance, designed to relate osteotomy or fixture position to existing anatomic structures, to be utilized during radiographic exposure for treatment planning and/or during osteotomy creation for fixture installation. Examples are mechanical guides that direct the mesio-distal and bucco-lingual angulation of the drill path over the ostetomy site, and are adjustable during pre-surgical planning, radiographic indexing and again prior to the osteotomy. Yea Nay 0 Accept Decline X Current CDT Code D690 may be used to document the procedure as described in the submission as it is a by report code that anticipates description of the type of guide or index. The full D690 CDT Code entry is: D690 radiographic/surgical implant index, by report Abstain 0 Other An appliance, designed to relate osteotomy or fixture position to existing anatomic structures, to be utilized during radiographic exposure for treatment planning and/or during osteotomy creation for fixture installation.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 59 OF 04 Inventory # 5. CID IMP-0 D6xxx Action Add Dr. Williams radiographic/surgical implant index, non-limiting A non-limiting appliance, designed to relate osteotomy or fixture position to existing anatomic structures, to be utilized during radiographic exposure for treatment planning and/or during osteotomy creation for fixture installation. Examples are traditional suck down acrylic guides with a hole over the ostetomy site. Yea Nay 0 Accept Decline X Current CDT Code D690 may be used to document the procedure as described in the submission as it is a by report code that anticipates description of the type of guide or index. The full D690 CDT Code entry is: D690 radiographic/surgical implant index, by report Abstain 0 Other An appliance, designed to relate osteotomy or fixture position to existing anatomic structures, to be utilized during radiographic exposure for treatment planning and/or during osteotomy creation for fixture installation.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 60 OF 04 Inventory # 54. CID IMP-0 D6xxx Action Add Dr. Williams radiographic/surgical implant index, guided A guided appliance, designed to relate osteotomy or fixture position to existing anatomic structures, to be utilized during radiographic exposure for treatment planning and/or during osteotomy creation for fixture installation. Examples are guides with sleeves or other methods that direct the mesio-distal and buccolingual angulation of the drill path over the ostetomy site. Yea Nay 0 Accept Decline X Current CDT Code D690 may be used to document the procedure as described in the submission as it is a by report code that anticipates description of the type of guide or index. The full D690 CDT Code entry is: D690 radiographic/surgical implant index, by report Abstain 0 Other An appliance, designed to relate osteotomy or fixture position to existing anatomic structures, to be utilized during radiographic exposure for treatment planning and/or during osteotomy creation for fixture installation.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 6 OF 04 Inventory # 55. CID IMP-04a D6xxx Action Add DDPA implant /abutment supported removable denture for completely edentulous arch maxillary implant /abutment supported removable denture for completely edentulous arch mandibular implant /abutment supported removable denture for partially edentulous arch maxillary implant /abutment supported removable denture for partially edentulous arch mandibular None The CMC accepted a motion to amend two proposed nomenclatures, as highlighted above as it considers completely and edentulous redundant. Yea Accept X Nay 6 Decline Abstain 4 Other 4

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 6 OF 04 Inventory # 56. CID IMP-04b D6xxx Action Add DDPA implant /abutment supported fixed denture for completely edentulous arch maxillary implant /abutment supported fixed denture for completely edentulous arch mandibular implant /abutment supported fixed denture for partially edentulous arch maxillary by quadrant implant /abutment supported fixed denture for partially edentulous arch mandibular None The CMC accepted a motion to amend two proposed nomenclatures, as highlighted above as it considers completely and edentulous redundant. Yea Accept X Nay 6 Decline Abstain 4 Other 4

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 6 OF 04 Inventory # 57. CID IMP-04c D605/D6054/D6078/D6079 Action Delete DDPA implant/abutment supported removable denture for completely edentulous arch implant/abutment supported removable denture for partially edentulous arch implant/abutment supported fixed denture for completely edentulous arch implant/abutment supported fixed denture for partially edentulous arch A prosthesis that is retained, supported and stabilized by implants or abutments placed on implants but does not have specific relationships between implant positions and replacement teeth; may be screw retained or cemented; commonly referred to as a hybrid prosthesis. Yea Accept X Nay 6 Decline Abstain 4 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 64 OF 04 Inventory # 58. CID IMP-05 D6065 Action Revise Dr. Kouri The submission contains the following response to question 5# Full text of requested Nomenclature D6065-67 Implant Supported Crowns and D6057 Custom Abutment The submission contains the following response to question 5# Full text of requested Descriptor Implant crowns screwed directly to the implant. Yea 0 Accept Nay Decline X The Code Maintenance Committee is unable to discern the requestor s intentions from the submitted documentation Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 65 OF 04 Inventory # 59. CID IMP-06 D60 Action Revise AAP debridement of a peri-implant defect or defects surrounding a single implant, and surface cleaning of the exposed implant surfaces, including flap entry and closure None Yea 8 Accept X Nay Decline Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 66 OF 04 Inventory # 60. CID IMP-07 D60 Action Revise AAP debridement and osseous contouring of a peri-implant defect; or defects surrounding a single implant and includes surface cleaning of the exposed implant surfaces and,including flap entry and closure None Yea 8 Accept X Nay Decline Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 67 OF 04 Inventory # 6. CID IMP-08 D60 Action Revise AAP bone graft for repair of peri-implant defect does not includinge flap entry and closure. or, when indicated, Pplacement of a barrier membrane or biologic materials to aid in osseous regeneration are reported separately None Yea 8 Accept X Nay Decline Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 68 OF 04 Inventory # 6. CID PRF-0 D6xxx Action Add CDBP resin retainer resin for resin bonded fixed prosthesis None The CMC accepted a motion to change the nomenclatures word sequence, as highlighted above, for clarity. Yea 9 Accept X Nay 0 Decline Abstain Other 4

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 69 OF 04 Inventory # 6. CID PRF-0 D6975 Action Delete CDBP coping To be used as a definitive restoration when coping is an integral part of a fixed prosthesis. Yea 8 Accept X Nay Decline Abstain Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 70 OF 04 Inventory # 64. CID OMS-0 D7xxx Action Add CDBP removal of temporary anchorage device, requiring flap None Yea 0 Accept Nay Decline X Abstain 0 Other CDT Codes D79 D794 as revised for CDT 05 retain Includes device removal. in their descriptors, thereby rendering moot this request to parse the removal procedure.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 7 OF 04 Inventory # 65. CID OMS-0 D7xxx Action Add CDBP removal of temporary anchorage device, not requiring flap None Yea 0 Accept Nay Decline X Abstain 0 Other CDT Codes D79 D794 as revised for CDT 05 retain Includes device removal. in their descriptors, thereby rendering moot this request to parse the removal procedure.

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 7 OF 04 Inventory # 66. CID OMS-05 D79 Action Revise CDBP surgical placement: of temporary anchorage device [screw retained plate] requiring surgical flap Insertion of a temporary skeletal anchorage device that is attached to the bone by screws and requires a surgical flap. Includes device removal. 4 5 The CMC considered, by consensus, the following revised submission: D79 surgical placement: of temporary anchorage device [screw retained plate] requiring surgical flap; includes device removal Insertion of a temporary skeletal anchorage device that is attached to the bone by screws and requires a surgical flap. Includes device removal. Yea 9 Accept X Nay Decline Accepted as revised Abstain Other 6

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 7 OF 04 Inventory # 67. CID OMS-06 D79 Action Revise CDBP surgical placement: of temporary anchorage device requiring surgical flap Insertion of a device for temporary skeletal anchorage when a surgical flap is required. Includes device removal. 4 5 The CMC considered, by consensus, the following revised submission: D79 surgical placement: of temporary anchorage device requiring surgical flap; includes device removal Insertion of a device for temporary skeletal anchorage when a surgical flap is required. Includes device removal. Yea 9 Accept X Nay Decline Accepted as revised Abstain Other 6

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 74 OF 04 Inventory # 68. CID OMS-07 D794 Action Revise CDBP surgical placement: of temporary anchorage device without surgical flap Insertion of a device for temporary skeletal anchorage when a surgical flap is not required. Includes device removal. 4 5 The CMC considered, by consensus, the following revised submission: D794 surgical placement: of temporary anchorage device without surgical flap; includes device removal Insertion of a device for temporary skeletal anchorage when a surgical flap is not required. Includes device removal. Yea 9 Accept X Nay Decline Accepted as revised. Abstain Other 6

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 75 OF 04 Inventory # 69. CID OMS-0 D785 Action Revise AAOMS incisional biopsy of oral tissue-hard (bone, tooth) For partial removal of specimen only. This code involves biopsy of osseous lesions and is not used for apicoectomy/periradicular surgery. This code does not entail an excision. 4 5 Descriptor editorial changes arose during CMC review of the Action Report draft. These editorial actions are highlighted in the following text: For partial removal of specimen only. This procedure code involves biopsy of osseous lesions and is not used for apicoectomy/periradicular surgery. This procedure code does not entail an excision. Yea 0 Accept X Nay Decline Abstain 0 Other 6

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 76 OF 04 Inventory # 70. CID OMS-04 D786 Action Revise AAOMS incisional biopsy of oral tissue-soft For partial removal of an architecturally intact specimen only. This code is not used at the same time as codes for apicoectomy/periradicular curettage. This code does not entail an excision. 4 5 Descriptor editorial changes arose during CMC review of the Action Report draft. These editorial actions are highlighted in the following text: For partial removal of an architecturally intact specimen only. This procedure code is not used at the same time as codes for apicoectomy/periradicular curettage. This procedure code does not entail an excision. Yea 0 Accept X Nay Decline Abstain 0 Other 6

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 77 OF 04 Inventory # 7. CID ORT-0 D8xxx Action Add Dr. Keiles/ PROPEL Orthodontics micro-osteoperforations Creation of small perforations around the roots of teeth, no flap is needed. Yea 0 Accept Nay Decline X This is a proprietary procedure that is product specific. Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 78 OF 04 Inventory # 7. CID ORT-0 D8660 Action Revise CDBP pre-orthodontic treatment visit examination to monitor growth and development Periodic observation of patient dentition, at intervals established by the dentist, to determine when orthodontic treatment should begin. Diagnostic procedures are documented separately. Yea 6 Accept X Nay 5 Decline Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 79 OF 04 Inventory # 7. CID ORT-0 D8670 Action Revise Dr. Lozman periodic orthodontic treatment visit (as part of contract with patient) None 4 The CMC accepted a motion to amend the proposed nomenclature change, as highlighted above, considering reference to a contract as not part of the clinical procedure addressed by the CDT Code entry. Yea Accept X Nay 0 Decline Accepted as amended Abstain 0 Other 5

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 80 OF 04 Inventory # 74. CID ADJ-0 D9xxx Action Revise NADP missed appointment None Yea 9 Accept X Nay Decline Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 8 OF 04 Inventory # 75. CID ADJ-0 D9xxx Action Add CDBP missed appointment Without prior notice. Yea Accept Nay 0 Decline X Declined in favor of Inventory #74 Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 8 OF 04 Inventory # 76. CID ADJ-0 D9xxx Action Add NADP cancelled appointment None Yea 8 Accept X Nay Decline Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 8 OF 04 Inventory # 77. CID ADJ-04 D9xxx Action Add CDBP cancelled appointment insufficient notice per practice policy None Yea Accept Nay 0 Decline X Declined in favor of accepted inventory #76 Abstain 0 Other

04 CDBP CODE MAINTENANCE COMMITTEE (CMC) ACTION REPORT SUBSTANTIVE ACTION SUBMISSIONS PAGE 84 OF 04 Inventory # 78. CID ADJ-06 D9xxx Action Add CDBP patient arrived late for office visit None Yea 4 Accept Nay 6 Decline X The CMC did not see the need for this granular level of documentation. Abstain Other