ADA Code	No PA Required	PA Required	Not Covered by AHCCCS	Payable for 21 years of age and over
Diagnostic
D0120	X
D0140	X			X
D0145	X (max. age of 2)
D0150	X
D0160		X
D0170			X
D0180		X
Radiographs
D0210	X (limited to 1every 3 years)
D0220 -D0240	X			X
D0250	X
D0260	X
D0270	X			X
D0272	X (max. age of 20)			X
D0273	X
D0274	X
D0277 - D0321		X
D0322			X
D0330	X (limited to 1 every 3 years)
D0340		X (max. age of 20)
D0350		X (max. age of 20)
D0360 - D0363			X
Labs
D0415 - D0460			X
D0470		X
D0472 - D0502			X
D0999		X
Prophylaxis
D1110	X ages 15-20 11/07 revised 14 & up
D1120	X max age 20 (6 months frequency)   11/07 revised 0-13
D1203	X (only covered with a cleaning) ages 0-14   11/07 revised 0-13
D1204	X (only covered with a cleaning) ages 15-20   11/07 revised 14 & up
D1206 (New Code)	X (only covered with a cleaning)
D1310 - D1330			X
D1351	X (limited to 1st & 2nd molars) Baby teeth A, J, K & T.  Adult teeth 2, 3, 14, 15, 18, 19, 30, 31.
Space Maintainers
D1510 - D1550	X (max. age of 14)
D1555 (New Code)	X (max. age of 20)
Restorative
D2140 - D2161	X
Resins
D2330 - D2332	X
D2335	X			X
D2390		X
D2391 - D2394	X
D2410 - D2664			X
Crowns
D2710 - D2740			X
D2750		X (For ages 18-20 only)
D2751		X (with root canal therapy only for ages 18 - 20)
D2752		X (with root canal therapy only for ages 18 - 20)
D2780 - D2783			X
D2790		X (For ages 18-20 only)
D2791		X  (with root canal therapy only for ages 18 - 20)
D2792		X (with root canal therapy only for ages 18 - 20)
D2794		X
D2799			X
D2910	X (minimum age 18)			X
D2915	X			X
D2920	X			X
D2930	X (max. age of 14)
D2931		X (minimum age 6)		X
D2932		X (minimum age 6)		X
D2933		X
D2934		X  (covered ages 0-20 only)
D2940	X
D2950 - D2952		X
D2953			X
D2954		X
D2955 - D2980			X
D2999		X
Endodontics
D3110	X ( maximum age 20)
D3120	X (maximum age 20)
D3220	X			X
D3221	X
D3230		X  (maximum age of 12)
D3240		X (maximum age of 14)
D3310 - D3353		X
D3410		X		X
D3421 - D3450		X
D3460 - D3910			X
D3920		X
D3950			X
D3999		X
Periodontics
D4210		X
D4211		X
D4230 (New Code)			X
D4231 (New Code)	X
D4240		X
D4241		X
D4245			X
D4249 - D4267		X
D4268			X
D4270 - D4355		X
D4381			X
D4910 - D4999		X
Prosthodontics
D5110 - D5214		X
D5225			X
D5226			X
D5281 - D5660		X
D5670			X
D5671			X
D5710 - D5761		X
D5810			X
D5811			X
D5820 - D5851		X
D5860 - D5875			X
D5899 - D5937		X
D5951		X (maximum age 2)
D5952		X (ages 0-16 only)
D5953		X (minimum age 16)
D5954 - D5999		X
Implant Services
D6010 - D6985			X
D6999		X (minimum age 18)
Oral Surgery
D7111 - D7210	X			X
D7220		X		X
D7230 - D7241		X
D7250		X		X
D7260 - D7261		X
D7270	X			X
D7272			X
D7280 - D7283		X
D7285	X
D7286	X
D7287 - D7291			X
D7292 - D7310		X
D7311		X (covered ages 0-20 only)
D7320  (Revised)		X
D7321		X (covered ages 0-20 only)
D7340			X
D7350			X
D7410 - D7490		X
D7510	X			X
D7511	X			X
D7520 - D7540	X
D7550		X
D7560		X
D7610 - D7640		X		X
D7650 - D7899		X
Suturing
D7910 - D7912	X
D7920 - D7951		X
D7953		X (max. age of 20)
D7955		X
D7960		X
D7963		X (max. age of 20)
D7970		X
D7971	X
D7972 - D7983		X
D7990	X
D7991 - D7999		X
Other
D8000-D8999			X
D9110	X			X
D9120 (New Code)		X
D9210	X
D9211 - D9215			X
D9220		X
D9221		X
D9230	X			X
D9241 - D9248		X		X
D9310 - D9440		X
D9450			X
D9610			X
D9612 (New Code)		X
D9630 - D9630			X
D9920		Pay by REPORT only (max. age of 20)
D9930		X
D9940		X (max. age of 20)
D9941 - D9950			X
D9951		X (max. age of 20)
D9952 - D9974			X
D9999		X  (max. age of 20)