Updated: January 2026
Purpose
The following valid values are required on service authorizations and claims for payment.
Areas of the Oral Cavity
00
- Designates the whole of the oral cavity
01
- Designates the maxillary area
02
- Designates the mandibular area
10
- Designates the upper right quadrant
20
- Designates the upper left quadrant
30
- Designates the lower left quadrant
40
- Designates the lower right quadrant
Tooth Surface
- I - Incisal
- F - Facial
- O - Occlusal
- L - Lingual
- B - Buccal
- M - Mesial
- D - Distal
Tooth and Supernumerary Number
| Tooth Number | Supernumerary Number |
|---|---|
| 1 | 51 |
| 2 | 52 |
| 3 | 53 |
| 4 | 54 |
| 5 | 55 |
| 6 | 56 |
| 7 | 57 |
| 8 | 58 |
| 9 | 59 |
| 10 | 60 |
| 11 | 61 |
| 12 | 62 |
| 13 | 63 |
| 14 | 64 |
| 15 | 65 |
| 16 | 66 |
| 17 | 67 |
| 18 | 68 |
| 19 | 69 |
| 20 | 70 |
| 21 | 71 |
| 22 | 72 |
| 23 | 73 |
| 24 | 74 |
| 25 | 75 |
| 26 | 76 |
| 27 | 77 |
| 28 | 78 |
| 29 | 79 |
| 30 | 80 |
| 31 | 81 |
| 32 | 82 |
| A | AS |
| B | BS |
| C | CS |
| D | DS |
| E | ES |
| F | FS |
| G | GS |
| H | HS |
| I | IS |
| J | JS |
| K | KS |
| L | LS |
| M | MS |
| N | NS |
| O | OS |
| P | PS |
| Q | QS |
| R | RS |
| S | SS |
| T | TS |
Contact
Medical Services
600 East Boulevard Ave
Bismarck, ND 58505-0250
Phone: (701) 328-2310
Email: dhsmedicalservices@nd.gov
Policy Updates
January 2026
- Policy created.
January 2027
- Sextant values removed