| Diagnostic |
| 1. Initial Exam D0150 |
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2. Periodic Exam Only D0120 |
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3. Comprehensive Perio Exam D0180 |
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4. Full Mouth X-Rays D0210 |
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5. 2 Bitewings D0272 |
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6. 4 Bitewings D0274 |
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7. Panoramic X-Rays D0330 |
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8. Prophy Adult D1110 |
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9. Prophy Pedo D1120 |
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10. Perio Maintenance D4910 |
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11. Curettage/Root Plane D4341 |
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12. Child FLuoride D1203 |
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13. Adult Fluoride D1204 |
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14. Fluoride Varnish D1206 |
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15. Sealants - Each D1351
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Permanent Amalgam Restoration |
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16. 1 Surface D2140 |
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17. 2 Surface D2150 |
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18. 3 Surface D2160
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| Anterior Composite Restoration |
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19. 1 Surface D2330 |
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20. 2 Surface D2331 |
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21. 3 Surface D2332
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Posterior Composite Restoration |
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22. 1 Surface D2391 |
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23. 2 Surface D2392 |
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24. 3 Surface D2393
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Endodontics |
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25. Anterior Canal D3310 |
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26. Pre-Molar Canal D3320 |
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27. Molar Canal D3330 |
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28. Pulpotomy D3220
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Extraction |
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29. Simple First D7110 |
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30. Surgical Erupted D7210 |
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31. Surgical Soft Tissue Impacted D7220
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Crown & Bridge |
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32. Full Coverage Gold D2790 or D2792 |
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33. Porcelain to Gold D2750 or D2752 |
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34. Porcelain D2740
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Dentures |
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35. Full Set D5110 + D5120
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Partials |
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36. Upper or Lower D5213, D5214
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37. Custom Abutment D6057
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38. Abut. Supported porcelain to ceramic FPD D6068
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39. Abut. Supported porcelain to metal FPD D6069
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Comments
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