periodic Exam

0120

Limited Exam

0140

Comprehensive Exam

0150

full mouth series

0210

Under 3y/o Exam

0145

periapical X-ray

0220

additional PA

0230

2 bitewing

0272

4 bitewing

0274

pano

0330

Prophy-Adult

1110

Prophy-Child

1120

flouride

1208

space maintainer- fixed- unilateral

1510

space maintainer -fixed bilateral

1516

space maintainer -RMVBLE - bilateral Max

1526

Space maintainer- RMVBLE - Unilateral Band

1527

Sealent

1351

Pallative tx for pain

9110

Nitrous

9230

occlusal Guard Hard appliance full arch

9944

Occlusal Guard Soft appliance full arch

9945

indirect pulp cap ( IPC)

3120

Pulp (permanent teeth)

3221

Anterior Pulp (Baby tooth)

3230

posterior pulp (baby tooth)

3240

anterior root canal

3310

biscup root canal

3320

molar root canal

3330

prefab post & core

2954

Build up

2950

Flap and SCRP

4240

scaling & root planing

4341

scaling & root planing 1-3 teeth same quad

4342

full mouth debridement

4355

perio maintaince

4910

gingivectomy (needs perio charting

4211

Simple Ext (Baby tooth )

7140

surgical Ext

7210

Surgical Ext soft tissue impaction

7220

surgical ext partial bony impaction

7230

surgical ext full bony impaction

7240

surgical removal of residual root tips

7250

Alveoplasty w/ ext per quad

7310

Alveoplasty w/ ext 1-3 teeth

7311

IND

7510

Amalgon 1 surface

2140

Amalgon 2 surface

2150

amalgon 3 surface

2160

Amalgon 4 surface

2161

Anterior composite 1 surface

2330

Anterior composite 2 surface

2331

Anterior composite 3 surface

2332

Anterior composite 4 surface

2335

posterior composite 1 surface

2391

posterior composite 2 surface

2392

posterior composite 3 surface

2393

posterior composite 4 surface

2394

Crown-procelain

2740

crown procelain fused to base metal (PMF)

2751

crown full gold

2790

crown full cast metal (Mdcd) (not gold)

2791

crown-stainless steel permanent molar prefab

2931

bridge abutment procelain fused to base metal

6751

bridge pontic- porc fused to base metal

6241

bridge abutment procelain - ceramic

6740

bridge pontic procelain - ceramic

6245

fixed partial denture sectioning

9120

crown lengthing

4249

crown- stainless steel primary prefab (ssc)

2930

treatment simulation using 3d image (tero scan)

0393

comprehensive adolescent treatment

8080

comprehensive adult treatment

8090

periodic orthodontic treatment visit

8670

orthodontic retention

8680

replacement of lost or broken retainer

8692

unspecified orthodontic procedure by report

8999

complete upper denture

5110

complete lower denture

5120

immidiate upper denture

5130

immidiate lower denture

5140

upper partial resin-base

5211

lower partial resin-base

5212

upper partial

5213

lower partial

5214

adjust complete denture max

5410

adjust complete denture man

5411

adjust partial denture max

5421

adjust partial denture man

5422