|
| Description of oral healthcare service (OHCS) classifications | Without GA | Without GA | With GA | With GA |
| without CC | with CC | without CC | with CC |
|
| Skull, Operative procedures, level 3 | M0202300 | M0202301 | M0202310 | M0202311 |
| Face, Operative procedures, level 1 | M0702100 | M0702101 | M0702110 | M0702111 |
| Maxilla, Operative procedures, level 1 | M0802100 | M0802101 | M0802110 | M0802111 |
| Maxilla, Operative procedures, level 2 | M0802200 | M0802201 | M0802210 | M0802211 |
| Maxilla, Operative procedures, level 3 | M0802300 | M0802301 | M0802310 | M0802311 |
| Mandible, Diagnostic procedures and nonoperative procedures, level 1 | M0901100 | M0901101 | M0901110 | M0901111 |
| Mandible, Diagnostic procedures and nonoperative procedures, level 2 | M0901200 | M0901201 | M0901210 | M0901211 |
| Mandible, Diagnostic procedures and nonoperative procedures, level 3 | M0901300 | M0901301 | M0901310 | M0901311 |
| Mandible, Operative procedures, level 1 | M0902100 | M0902101 | M0902110 | M0902111 |
| Mandible, Operative procedures, level 2 | M0902200 | M0902201 | M0902210 | M0902211 |
| Mandible, Operative procedures, level 3 | M0902300 | M0902301 | M0902310 | M0902311 |
| Facial bone, Operative procedures, level 2 | M1002200 | M1002201 | M1002210 | M1002211 |
| Facial bone, Operative procedures, level 3 | M1002300 | M1002301 | M1002310 | M1002311 |
| Nose, Repair or reconstruction, level 1 | M1906100 | M1906101 | M1906110 | M1906111 |
| Nose, Other procedures and operations, level 1 | M1999100 | M1999101 | M1999110 | M1999111 |
| Nasal cavity, Removal and replacement of nasal packing and Control of epistaxis level 1 | M2009100 | M2009101 | M2009110 | M2009111 |
| Nasal cavity, Other procedures and operations, level 1 | M2099100 | M2099101 | M2099110 | M2099111 |
| Nasal cavity, Other procedures and operations, level 2 | M2099200 | M2099201 | M2099210 | M2099211 |
| Nasal septum, Repair or reconstruction, level 3 | M2206300 | M2206301 | M2206310 | M2206311 |
| Frontal nasal sinuses, Repair or reconstruction, level 1 | M2306100 | M2306101 | M2306110 | M2306111 |
| Frontal nasal sinuses, Repair or reconstruction, level 2 | M2306200 | M2306201 | M2306210 | M2306211 |
| Frontal nasal sinuses, Repair or reconstruction, level 3 | M2306300 | M2306301 | M2306310 | M2306311 |
| Paranasal sinuses, Incision and Excision or destruction, level 1 | M2504100 | M2504101 | M2504110 | M2504111 |
| Parotid salivary gland, Incision and Excision or destruction, level 1 | M2604100 | M2604101 | M2604110 | M2604111 |
| Parotid salivary gland, Incision and Excision or destruction, level 2 | M2604200 | M2604201 | M2604210 | M2604211 |
| Salivary gland and duct, Incision and Excision or destruction, level 1 | M2804100 | M2804101 | M2804110 | M2804111 |
| Salivary gland and duct, Incision and Excision or destruction, level 2 | M2804200 | M2804201 | M2804210 | M2804211 |
| Neck, Diagnostic procedures and nonoperative procedures, level 1 | M2901100 | M2901101 | M2901110 | M2901111 |
| Neck, Diagnostic procedures and nonoperative procedures, level 2 | M2901200 | M2901201 | M2901210 | M2901211 |
| Neck skin, Diagnostic procedures and nonoperative procedures, level 1 | M3001100 | M3001101 | M3001110 | M3001111 |
| Neck skin, Operative procedures, level 1 | M3002100 | M3002101 | M3002110 | M3002111 |
| Neck skin, Operative procedures, level 2 | M3002200 | M3002201 | M3002210 | M3002211 |
| Neck skin, Operative procedures, level 3 | M3002300 | M3002301 | M3002310 | M3002311 |
| Carotid artery, Operative procedures, level 1 | M3202100 | M3202101 | M3202110 | M3202111 |
| Carotid artery, Operative procedures, level 2 | M3202200 | M3202201 | M3202210 | M3202211 |
| Cervical lymph nodes, Diagnostic procedures and nonoperative procedures, level 1 | M3301100 | M3301101 | M3301110 | M3301111 |
| Cervical lymph nodes, Diagnostic procedures and nonoperative procedures, level 2 | M3301200 | M3301201 | M3301210 | M3301211 |
| Thyroglossal reminant, Incision and Excision or destruction, level 1 | M3504100 | M3504101 | M3504110 | M3504111 |
| Thyroglossal reminant, Incision and Excision or destruction, level 2 | M3504200 | M3504201 | M3504210 | M3504211 |
| Lip, Incision and Excision or destruction, level 1 | M3604100 | M3604101 | M3604110 | M3604111 |
| Lip, Incision and Excision or destruction, level 2 | M3604200 | M3604201 | M3604210 | M3604211 |
| Lip, Repair or reconstruction, level 1 | M3606100 | M3606101 | M3606110 | M3606111 |
| Lip, Repair or reconstruction, level 2 | M3606200 | M3606201 | M3606210 | M3606211 |
| Floor of mouth, Incision and Excision or destruction, level 1 | M3804100 | M3804101 | M3804110 | M3804111 |
| Mouth, Diagnostic procedures and nonoperative procedures, level 1 | M3901100 | M3901101 | M3901110 | M3901111 |
| Mouth, Miscellaneous procedures, level 1 | M3903100 | M3903101 | M3903110 | M3903111 |
| Mouth, Incision and Excision or destruction, level 1 | M3904100 | M3904101 | M3904110 | M3904111 |
| Mouth, Incision and Excision or destruction, level 2 | M3904200 | M3904201 | M3904210 | M3904211 |
| Mouth, Repair or reconstruction, level 1 | M3906100 | M3906101 | M3906110 | M3906111 |
| Tongue, Incision and Excision or destruction, level 1 | M4004100 | M4004101 | M4004110 | M4004111 |
| Deciduous teeth, General procedures, level 1 | M4210100 | M4210101 | M4210110 | M4210111 |
| Permanent teeth, General procedures, level 1 | M4310100 | M4310101 | M4310110 | M4310111 |
| Permanent teeth, General procedures, level 2 | M4310200 | M4310201 | M4310210 | M4310211 |
| Soft palate, Repair or reconstruction, level 1 | M4606100 | M4606101 | M4606110 | M4606111 |
| Soft palate, Repair or reconstruction, level 2 | M4606200 | M4606201 | M4606210 | M4606211 |
| Uvula, Repair or reconstruction, level 1 | M4706100 | M4706101 | M4706110 | M4706111 |
| Uvula, Repair or reconstruction, level 2 | M4706200 | M4706201 | M4706210 | M4706211 |
| Uvula, Other procedures and operations on oral cavity, level 1 | M4799100 | M4799101 | M4799110 | M4799111 |
| Uvula, Other procedures and operations on oral cavity, level 2 | M4799200 | M4799201 | M4799210 | M4799211 |
| Uvula, Other procedures and operations on oral cavity, level 3 | M4799300 | M4799301 | M4799310 | M4799311 |
| Oral examination, Oral examination procedures, level 1 | D0121100 | D0121101 | D0121110 | D0121111 |
| Radiographs/Diagnostic imaging, Intraoral film, level 1 | D0222100 | D0222101 | D0222110 | D0222111 |
| Radiographs/Diagnostic imaging, Extraoral film, level 1 | D0223100 | D0223101 | D0223110 | D0223111 |
| Preventive Dentistry, Preventive Dentistry procedures, level 1 | D0324100 | D0324101 | D0324110 | D0324111 |
| Tooth Restoration, Amalgam restorations (including polishing), level 1 | D0526100 | D0526101 | D0526110 | D0526111 |
| Tooth Restoration, Resin-based composite restorations, level 1 | D0527100 | D0527101 | D0527110 | D0527111 |
| Tooth Restoration, Resin-based composite restorations, level 2 | D0527200 | D0527201 | D0527210 | D0527211 |
| Tooth Restoration, Crown-single restorations only, level 1 | D0530100 | D0530101 | D0530110 | D0530111 |
| Tooth Restoration, Crown-single restorations only, level 2 | D0530200 | D0530201 | D0530210 | D0530211 |
| Endodontic Treatment, Endodontic Treatment procedures, level 2 | D0631200 | D0631201 | D0631210 | D0631211 |
| Endodontic Treatment, Endodontic therapy on permanent teeth, level 1 | D0633100 | D0633101 | D0633110 | D0633111 |
| Endodontic Treatment, Endodontic therapy on permanent teeth, level 2 | D0633200 | D0633201 | D0633210 | D0633211 |
| Endodontic Treatment, Apicoectomy/Periradicular services, level 2 | D0634200 | D0634201 | D0634210 | D0634211 |
| Periodontal Treatment, Periodontal Treatment procedures, level 1 | D0735100 | D0735101 | D0735110 | D0735111 |
| Periodontal Treatment, Surgical services (Including usual postoperative care), level 1 | D0736100 | D0736101 | D0736110 | D0736111 |
| Periodontal Treatment, Surgical services (Including usual postoperative care), level 2 | D0736200 | D0736201 | D0736210 | D0736211 |
| Prosthodontics, Prosthodontics (Removable), level 1 | D0837100 | D0837101 | D0837110 | D0837111 |
| Prosthodontics, Prosthodontics (Removable), level 2 | D0837200 | D0837201 | D0837210 | D0837211 |
| Prosthodontics, Fixed partial denture retainers-crown, level 2 | D0838200 | D0838201 | D0838210 | D0838211 |
| Prosthodontics, Other fixed partial denture service, level 2 | D0841200 | D0841201 | D0841210 | D0841211 |
| Implant services, Implant services procedures, level 2 | D0943200 | D0943201 | D0943210 | D0943211 |
| Orthodontic treatment, Other orthodontic service, level 1 | D1049100 | D1049101 | D1049110 | D1049111 |
| Oral health problems, Other and unspecified management of oral health problems procedures, level 1 | D1251100 | D1251101 | D1251110 | D1251111 |
| Two procedures in one visit, M and M, complexity level 3 and level 3 | P2200100 | P2200101 | P2200110 | P2200111 |
| Two procedures in one visit, D and D, complexity level 2 and level 2 | P2020400 | P2020401 | P2020410 | P2020411 |
| Two procedures in one visit, D and D, complexity level 2 and level 1 | P2020500 | P2020501 | P2020510 | P2020511 |
| Two procedures in one visit, D and D, complexity level 1 and level 1 | P2020600 | P2020601 | P2020610 | P2020611 |
| Two procedures in one visit, M and D, complexity level 3 and level 2 | P2110200 | P2110201 | P2110210 | P2110211 |
| Two procedures in one visit, M and D, complexity level 2 and level 2 | P2110500 | P2110501 | P2110510 | P2110511 |
| Two procedures in one visit, M and D, complexity level 2 and level 1 | P2110600 | P2110601 | P2110610 | P2110611 |
| Two procedures in one visit, M and D, complexity level 1 and level 2 | P2110800 | P2110801 | P2110810 | P2110811 |
| Two procedures in one visit, M and D, complexity level 1 and level 1 | P2110900 | P2110901 | P2110910 | P2110911 |
| Two procedures in one visit, M and M, complexity level 3 and level 3 | P2200100 | P2200101 | P2200110 | P2200111 |
| Two procedures in one visit, M and M, complexity level 3 and level 2 | P2200200 | P2200201 | P2200210 | P2200211 |
| Two procedures in one visit, M and M, complexity level 3 and level 1 | P2200300 | P2200301 | P2200310 | P2200311 |
| Two procedures in one visit, M and M, complexity level 2 and level 2 | P2200400 | P2200401 | P2200410 | P2200411 |
| Two procedures in one visit, M and M, complexity level 2 and level 1 | P2200500 | P2200501 | P2200510 | P2200511 |
| Two procedures in one visit, M and M, complexity level 1 and level 1 | P2200600 | P2200601 | P2200610 | P2200611 |
| Three procedures in one visit, D, D, and D, complexity level 2 and level 2 and level 1 | P3030800 | P3030801 | P3030810 | P3030811 |
| Three procedures in one visit, D, D, and D, complexity level 2 and level 1 and level 1 | P3030900 | P3030901 | P3030910 | P3030911 |
| Three procedures in one visit, D, D, and D, complexity level 1 and level 1 and level 1 | P3031000 | P3031001 | P3031010 | P3031011 |
| Three procedures in one visit, M, D, and D, complexity level 2 and level 2 and level 2 | P3121000 | P3121001 | P3121010 | P3121011 |
| Three procedures in one visit, M, D, and D, complexity level 2 and level 1 and level 1 | P3121200 | P3121201 | P3121210 | P3121211 |
| Three procedures in one visit, M, D, and D, complexity level 1 and level 2 and level 1 | P3121700 | P3121701 | P3121710 | P3121711 |
| Three procedures in one visit, M, D, and D, complexity level 1 and level 1 and level 1 | P3121800 | P3121801 | P3121810 | P3121811 |
| Three procedures in one visit, M, M, and D, complexity level 2 and level 1 and level 1 | P3211500 | P3211501 | P3211510 | P3211511 |
| Three procedures in one visit, M, M, and D, complexity level 1 and level 1 and level 1 | P3211800 | P3211801 | P3211810 | P3211811 |
| Three procedures in one visit, M, M, and M, complexity level 3 and level 2 and level 2 | P3300400 | P3300401 | P3300410 | P3300411 |
| Three procedures in one visit, M, M, and M, complexity level 3 and level 2 and level 1 | P3300500 | P3300501 | P3300510 | P3300511 |
| Three procedures in one visit, M, M, and M, complexity level 3 and level 1 and level 1 | P3300600 | P3300601 | P3300610 | P3300611 |
| Three procedures in one visit, M, M, and M, complexity level 2 and level 2 and level 1 | P3300800 | P3300801 | P3300810 | P3300811 |
| Three procedures in one visit, M, M, and M, complexity level 2 and level 1 and level 1 | P3300900 | P3300901 | P3300910 | P3300911 |
| Three procedures in one visit, M, M, and M, complexity level 1 and level 1 and level 1 | P3301000 | P3301001 | P3301010 | P3301011 |
| Four procedures in one visit, D, D, D, and D, complexity level 2 and level 2 and level 1 and level 1 | P4041300 | P4041301 | P4041310 | P4041311 |
| Four procedures in one visit, D, D, D, and D, complexity level 2 and level 1 and level 1 and level 1 | P4041400 | P4041401 | P4041410 | P4041411 |
| Four procedures in one visit, D, D, D, and D, complexity level 1 and level 1 and level 1 and level 1 | P4041500 | P4041501 | P4041510 | P4041511 |
| Four procedures in one visit, M, D, D, and D, complexity level 2 and level 1 and level 1 and level 1 | P4132000 | P4132001 | P4132010 | P4132011 |
| Four procedures in one visit, M, D, D, and D, complexity level 1 and level 2 and level 1 and level 1 | P4132900 | P4132901 | P4132910 | P4132911 |
| Four procedures in one visit, M, D, D, and D, complexity level 1 and level 1 and level 1 and level 1 | P4133000 | P4133001 | P4133010 | P4133011 |
| Four procedures in one visit, M, M, D, and D, complexity level 2 and level 1 and level 1 and level 1 | P4223000 | P4223001 | P4223010 | P4223011 |
| Four procedures in one visit, M, M, D, and D, complexity level 1 and level 1 and level 1 and level 1 | P4223600 | P4223601 | P4223610 | P4223611 |
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