|
Rating |
| 9900 Maxilla or mandible, chronic osteomyelitis or osteoradionecrosis of: |
|
| Rate as osteomyelitis, chronic under diagnostic code 5000 |
|
| 9901 Mandible, loss of, complete, between angles |
100 |
| 9902 Mandible, loss of approximately one-half: |
|
| Involving temporomandibular articulation |
50 |
| Not involving temporomandibular articulation |
30 |
| 9903 Mandible, nonunion of: |
|
| Severe |
30 |
| Moderate |
10 |
| Note - Dependent upon degree of motion and relative loss of masticatory function |
|
| 9904 Mandible, malunion of: |
|
| Severe displacement |
20 |
| Moderate displacement |
10 |
| Slight displacement |
0 |
| Note - Dependent upon degree of motion and relative loss of masticatory function |
|
| 9905 Temporomandibular articulation, limited motion of: |
|
| Inter-incisal range: |
|
| 0 to 10 mm |
40 |
| 11 to 20 mm |
30 |
| 21 to 30 mm |
20 |
| 31 to 40 mm |
10 |
| Range of lateral excursion: |
|
| 0 to 4 mm |
10 |
| Note - Ratings for limited inter-incisal movement shall not be combined with ratings for limited lateral excursion |
|
| 9906 Ramus, loss of whole or part of: |
|
| Involving loss of temporomandibular articulation |
|
| Bilateral |
50 |
| Unilateral |
30 |
| Not involving loss of temporomandibular articulation |
|
| Bilateral |
30 |
| Unilateral |
20 |
| 9907 Ramus, loss of less than one-half the substance of, not involving loss of continuity: |
|
| Bilateral |
20 |
| Unilateral |
10 |
| 9908 Condyloid process, loss of, one or both sides |
30 |
| 9909 Coronoid process, loss of: |
|
| Bilateral |
20 |
| Unilateral |
10 |
| 9911 Hard palate, loss of half or more: |
|
| Not replaceable by prosthesis |
30 |
| Replaceable by prosthesis |
10 |
| 9912 Hard palate, loss of less than half of: |
|
| Not replaceable by prosthesis |
20 |
| Replaceable by prosthesis |
0 |
| 9913 Teeth, loss of, due to loss of substance of body of maxilla or mandible without loss of continuity: |
|
| Where the lost masticatory surface cannot be restored by suitable prosthesis: |
|
| Loss of all teeth |
40 |
| Loss of all upper teeth |
30 |
| Loss of all lower teeth |
30 |
| All upper and lower posterior teeth missing |
20 |
| All upper and lower anterior teeth missing |
20 |
| All upper anterior teeth missing |
10 |
| All lower anterior teeth missing |
10 |
| All upper and lower teeth on one side missing |
10 |
| Where the loss of masticatory surface can be restored by suitable prosthesis |
0 |
| Note - These ratings apply only to bone loss through trauma or disease such as osteomyelitis, and not to the loss of the alveolar process as a result of periodontal disease, since such loss is not considered disabling |
|
| 9914 Maxilla, loss of more than half: |
|
| Not replaceable by prosthesis |
100 |
| Replaceable by prosthesis |
50 |
| 9915 Maxilla, loss of half or less: |
|
| Loss of 25 to 50 percent: |
|
| Not replaceable by prosthesis |
40 |
| Replaceable by prosthesis |
30 |
| Loss of less than 25 percent: |
|
| Not replaceable by prosthesis |
20 |
| Replaceable by prosthesis |
0 |
| 9916 Maxilla, malunion or nonunion of: |
|
| Severe displacement |
30 |
| Moderate displacement |
10 |
| Slight displacement |
0 |