| D1110 |
Prophylaxis-Adult |
123.00 |
| D0120 |
Periocic Oral Evaluation |
72.00 |
| D0230 |
Intraoral-Periapical Image Each Additonal |
32.00 |
| D0220 |
Intraoral-Periapical Image |
38.00 |
| D1206 |
Topical Application Fluoride Varnish |
49.00 |
| D0140 |
Limited Oral Evaluation |
94.00 |
| D2391 |
Resin Composite One Surface,Posterior |
222.00 |
| D2392 |
Resin Composite Two Surface, Posterior |
315.00 |
| D2740 |
Crown-Poercelain/Ceramic |
1856.00 |
| D7210 |
Extract, Single Erupted Tooth |
352.00 |
| D2950 |
Core Buildup, Including Any Pins |
352.00 |
| D2954 |
Prefabricated Post/Core in Addition to Crown |
461.00 |
| D9230 |
Analgesia-Inhale of Nitrous Oxide |
158.00 |
| D2330 |
Resin-One Surface, Anterior Tooth Filling |
198.00 |
| D1001 |
Clinpro Flouride 5000 |
29.00 |
