Occlusal Adjustment - Limited No No Not Covered D9952 Occlusal Adjustment - Complete No No Not Covered D9970 Enamel Microabrasion No No Not Covered D9971 Odontoplasty 1-2 Teeth; Includes Removal of Enamel No No Not Covered Projections D9972 External Bleaching Per Arch Performed In Office No NO Not Covered – External Bleaching Per Tooth No No Not Covered – D9974 Internal Bleaching Per Tooth No No Not Covered – D9975 External Bleaching For Home Application, Per Arch; NO NO Not Covered Includes Materials And Fabrication Of Custom Trays D9999 Unspecified Adjunctive Procedure, by Report YES YES YES YES By Report
Occlusal Adjustment - Limited No No Not Covered D9952 Occlusal Adjustment - Complete No No Not Covered D9970 Enamel Microabrasion No No Not Covered D9971 Odontoplasty 1-2 Teeth; Includes Removal of Enamel Projections No No Not Covered D9972 External Bleaching – Per Arch Performed In Office No NO Not Covered External Bleaching – Per Tooth No No Not Covered D9974 Internal Bleaching – Per Tooth No No Not Covered D9975 External Bleaching For Home Application, Per Arch; Includes Materials And Fabrication Of Custom Trays NO NO Not Covered D9999 Unspecified Adjunctive Procedure, by Report YES YES YES YES By Report
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