Teeth Numbers

Teeth numbers may be required in a prior request or an e-claim. They are set in Tooth no's field which is visible only when user selects Procedure Type = 6 – Dental code. If dental code requires teeth numbers, Tooth no's label becomes bold to indicate it is mandatory field, otherwise the label is regular.

User can specify one or several teeth numbers from the list below separating them with comma. The numbers may not be repeated.

PRIMARY DENTITION
Tooth name	Tooth no.	Supernumerary tooth no.
Upper right second molar	A	AS
Upper right first molar	B	BS
Upper right canine	C	CS
Upper right lateral incisor	D	DS
Upper right central incisor	E	ES
Upper left central incisor	F	FS
Upper left lateral incisor	G	GS
Upper left canine	H	HS
Upper left first molar	I	IS
Upper left second molar	J	JS
Lower left second molar	K	KS
Lower left first molar	L	LS
Lower left canine	M	MS
Lower left lateral incisor	N	NS
Lower left central incisor	O	OS
Lower right central incisor	P	PS
Lower right lateral incisor	Q	QS
Lower right canine	R	RS
Lower right first molar	S	SS
Lower right second molar	T	TS

PERMANENT DENTITION
Tooth name	Tooth no.	Supernumerary tooth no.
Upper right third molar	1	51
Upper right second molar	2	52
Upper right first molar	3	53
Upper right second premolar	4	54
Upper right first premolar	5	55
Upper right canine	6	56
Upper right lateral incisor	7	57
Upper right central incisor	8	58
Upper left central incisor	9	59
Upper left lateral incisor	10	60
Upper left canine	11	61
Upper left first premolar	12	62
Upper left second premolar	13	63
Upper left first molar	14	64
Upper left second molar	15	65
Upper left third molar	16	66
Lower left third molar	17	67
Lower left second molar	18	68
Lower left first molar	19	69
Lower left second premolar	20	70
Lower left first premolar	21	71
Lower left canine	22	72
Lower left lateral incisor	23	73
Lower left central incisor	24	74
Lower right central incisor	25	75
Lower right lateral incisor	26	76
Lower right canine	27	77
Lower right first premolar	28	78
Lower right second premolar	29	79
Lower right first molar	30	80
Lower right second molar	31	81
Lower right third molar	32	82

Note: teeth numbers are saved in Observations part of the transaction sent to Post Office.

Step 1. Click on Create New Prior Request button.
Electronic Prior Request - Authorization form opens. Patient Details tab is active.

Step 2. Go to Procedure Details tab, set:

- Type = 6 – Dental code;
- Procedure = 23115.

Tooth no's field appears. Label is bold – at least one tooth number is required.

Step 3. Enter the necessary teeth with comma: 51,53,54.
Exclamation mark near the field disappears.