| Maxillary/Mandibular Osteotomies |
| 21141 – Maxillary osteotomy, LeFort 1, one piece |
| 21145 – Maxillary osteotomy, LeFort 1, one piece w bone graft |
| 21142 – Maxillary osteotomy, two pieces, segment mvmt any direction, no bone graft |
| 21143 – Maxillary osteotomy, three+ pieces, seg mvmt any direction, no bone graft |
| 21188 – Midface osteotomy/recon (other than LeFort) w/ bone grafting |
| 21193 – Reconstruction of mandibular rami w/o bone graft |
| 21195 – Reconstruction of mandibular rami w/ bone graft |
| 21195 – Mandibular osteotomy w/o internal fixation (IVRO) |
| 21196 – Mandibular osteotomy w/ internal fixation (BSSO) |
| 21198 – Mandibular ostetomy, segmental (subapical) |
| 21085 – Oral Surgical splint (non-VSP) |
| 20690 – Mandibular distracters |
| Dentoalveolar |
| 41899 – Extraction of teeth (generic dental sx) |
| 40720 – Revision of cleft lip |
| 41874 – Alveoloplasty |
| 42210 – Palatoplasty for CP (w/ bone graft to ridge + obtaining graft) |
| 30600 – Oronasal repair |
| Trauma/Fractures |
| 21422 – ORIF maxillary fx (LeFort 1) |
| 21356 – OR zygomatic arch arch fx (Gillies approach) |
| 21360 – OR ZMC fx (depressed arch, molar tripod, no fixation) |
| 21365 – ORIF ZMC via multiple approaches |
| 21386 – OR orbital floor blowout fx |
| 21390 – OR orbital floor blowout fx w/ alloplastic implant |
| 21453 – CRIMF mandible fx |
| 21461 – ORIF mandible fx w/out CRIMF |
| 21462 – ORIF mandible fx w/ CRIMF |
| 21470 – ORIF mandible fx via multiple approached, including internal fixation and CRIMF |
| Pathology |
| 21030 – Excision/removal of benign tumor/cyst of maxilla |
| 21040 – Excision/removal of benign tumor/cyst of mandible |
| 21046 – Excision of benign tumor/cyst of mandible, requiring intraoral ostotomy (Intraoral resection of mandible) |
| 21047 – Excision of benign tumor/cyst of mandible, requiring extraoral ostotomy (Intraoral resection of mandible) |
| 21031 – Removal of mandibular exostosis |
| 21032 – Removal of maxillary/palatal torus |
| 21034 – Excision of malignany tumor of maxilla |
| 21044 – Excision of malignant tumor of mandible |
| 42440 – Excision of submandibular gland |
| Grafting |
| 20900 – Obtaining bone graft (minor) |
| 20902 – Obtaining bone graft (major) |
| 20926 – Fat graft (dermal) |
| 20956 – Iliac crest bone graft |
| 21210 – Bone graft to maxilla (including obtaining graft) |
| 21215 – Bone graft to mandible (includes obtaining graft) |
| 20955 – Fibular free flap to mandible |
| 38220 – BMAC (BM aspiration only) |
| 0232T – PRP injection, any site, incl harvesting and prep |
| Imaging |
| 70486 – CT MaxFac w/o contrast |
| 70487 – CT MaxFac w contrast |
| 70490 – CY Neck w/o contrast |
| 70491 – CY Neck w contrast |
| 70540 – MRI face/neck w/o contrast |
| 70540 – MRI face/neck w/o contrast |
| 70336 – MRI TMJ |
| 1922 – Sedation for imaging |
| I&D |
| 10060 – I&D of abscess, simple |
| 42700 – I&D of peritonsillar abscess |
| 42720 – Intraoral I&D of retropharyngeal or parapharyngeal space |
| 42725 – Extraoral I&D of retropharyngeal or parapharyngeal space |
| 41000 – Intraoral I&D of lingual space |
| 41005 – Intraoral I&D of sublingual space |
| 41007 – Intraoral I&D of submental |
| 41008 – Intraoral I&D of submandibular space |
| 41009 – Intraoral I&D of masticator space |
| 41015 – Extraoral I&D of sublingual space |
| 41016 – Extraoral I&D of submental space |
| 41017 – Extraoral I&D of submandibular space |
| 41018 – Extraoral I&D of masticator space |
| TMJ |
| 20605 – Arthrocentesis |
| 21070 – Coronoidectomy |
| 21240 – Arthroplasty of TMJ w/ autograft |
| 21490 – Open tx for TMJ dislocation |
| 29800 – Arthroscopy (diagnostic) |
| 29804 – Arthroscopy (w/ procedure) |
| 64612 – Chemodenervation of facial muscles (botox) |
| 21243 – TJR |
| D7880 – Occlusal splint therapy |
| Miscellaneous |
| 170 – Outpatient anesthesia for intraoral procedure |
| 20680 – Hardware removal |
| 64722 – Decompression of unspecified nerve |
| 21121 – Genioplasty |
| 170 – Examination under general anesthesia |
