Attention Providers of Section 25 Dental Services: CDT Code Updates

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Attention Providers of Section 25 Dental Services

Effective December 31, 2019, the following CDT codes will be discontinued:

  • D1550 re-cementation of space maintainer
  •  D1555 removal of fixed space maintainer
  •  D8691 repair of orthodontic appliance
  •  D8692 replacement of lost or broken retainer
  •  D8693 rebonding or recementing of fixed retainers 

Effective January 1, 2020, the following CDT codes will be opened:

  • D1551 re-cement or re-bond bilateral space maintainer – maxillary (Covered Services, under age 21 and all ICF-IID residents, No PA Required) Max Allow: $22.50
  • D1552 re-cement or re-bond bilateral space maintainer – mandibular (Covered Services, under age 21 and all ICF-IID residents, No PA Required) Max Allow: $22.50
  • D1553 re-cement or re-bond unilateral space maintainer – per quadrant (Covered Services, under age 21 and all ICF-IID residents, No PA Required) Max Allow: $22.50
  • D1556 removal of fixed unilateral space maintainer – per quadrant (Covered Services, under age 21 and all ICF-IID residents, No PA Required) Max Allow: $50.00
  • D1557 removal of fixed bilateral space maintainer – maxillary (Covered Services, under age 21 and all ICF-IID residents, No PA Required) Max Allow: $50.00
  • D1558 removal of fixed bilateral space maintainer – mandibular (Covered Services, under age 21 and all ICF-IID residents, No PA Required) Max Allow: $50.00
  • D8696 repair of orthodontic appliance – maxillary (Covered Services, under age 21 and all ICF-IID residents, PA Required) Max Allow: $75.00
  • D8697 repair of orthodontic appliance – mandibular (Covered Services, under age 21 and all ICF-IID residents, PA Required) Max Allow: $75.00
  • D8698 re-cement or re-bond fixed retainer – maxillary (Covered Services, under age 21 and all ICF-IID residents, No PA Required) Max Allow: $50.00
  • D8699 re-cement or re-bond fixed retainer– mandibular (Covered Services, under age 21 and all ICF-IID residents, No PA Required) Max Allow: $50.00
  • D8703 replacement of lost or broken retainer – maxillary (Covered Services, under age 21 and all ICF-IID residents, No PA Required) Max Allow: $125.00
  • D8704 replacement of lost or broken retainer – mandibular (Covered Services, under age 21 and all ICF-IID residents, No PA Required) Max Allow: $125.00

If you have any questions, please contact Rebecca Maranda at rebecca.a.maranda@maine.gov or at (207) 624-6963.