CODE SERVICE FREQUENCY BENEFIT DETAILS Other Bridge Services D6930 Recement (reglue) a bridge Unlimited 1 procedure per calendar year, that has fallen off not covered within 6 months of receiving bridge retainer (see covered retainer codes above) D6980 Repair of the pontic or Unlimited 1 procedure every 2 calendar retainer portion of bridge years, not covered within 6 months of receiving bridge pontic (see covered pontic codes above), not covered for a bridge supported by implants Extractions and Oral Surgery D7140 Routine or surgical Unlimited 1 extraction procedure code per D7210 extractions of erupted tooth per lifetime D7250 teeth or exposed roots D7310 Reshaping of bone at 1 alveoloplasty Only covered if performed on D7311 extraction site(s) in procedure code per same day as extractions preparation for a denture quadrant per procedure (alveoloplasty) lifetime D7440 Removal of malignant Unlimited Only covered if procedure is D7441 tumor in the upper or performed by a board certified lower jaw oral and maxillofacial surgeon Miscellaneous Services D9110 Minor dental procedure to 1 procedure per Only covered for an in-office relieve pain or discomfort calendar year dental emergency visit D9230 Nitrous Oxide (laughing 1 procedure per Only covered if comprehensive gas) sedation date of dental care (D2140-D9910) is performed service on same day D9910 Desensitizing medication 2 procedures per 2 topical fluoride treatments for tooth calendar year (D1208) or desensitizing medication applications (D9910) per calendar year, does not cover bases, liners or adhesives under fillings 11