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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | EXTRACTION - SINGLE TOOTH, REQUIRING INCISION OF OVERLYING SOFT TISSUE, ELEVATION OF FLAP, REMOVAL OF BONE OR SECTIONING | 320120 | 2004240 | 240 | |||
0 | FINISHING AND POLISHING OF AMALGAM | 320122 | 60 | ||||
RESTORATION, EACH | |||||||
0 | FIRST DENTAL VISIT � INCLUDES EXAMINATION / CHARTING/ TREATMENT PLAN / COST ESTIMATION AND THE NECESSARY X-RAYS | 320123 | 2003351 | 200 | |||
0 | FISSURE SEALANT | 97161-00[455] | 320124 | 2009930 | 120 | ||
0 | FISSURE SENTENT / TOOTH+HYGENIST | 97161-00[455] | 320125 | 2009930 | 120 | ||
0 | FIXED APPL. FOR BREAKING HABIT | 320126 | 2008220 | 640 | |||
0 | FIXED APPLIANCE - HABIT | 320127 | 2008220 | 6,500.00 | |||
0 | FIXED PARTIAL DENTURE (FOR ADULT) | 320128 | 2008220 | 400 | |||
0 | FIXED SPACE MAINT. BILAT. | 320129 | 2008220 | 1,000.00 | |||
0 | FIXED SPACE MAINT. UNILAT. TR. | 320130 | 2008220 | 580 | |||
0 | FRACT.MAX.LEFORT II ZYGOM ARCH & FRONT SUSP | 320131 | 21356 | 8,200.00 |
EXTRACTION - SINGLE TOOTH, REQUIRING INCISION OF OVERLYING SOFT TISSUE, ELEVATION OF FLAP, REMOVAL OF BONE OR SECTIONING
240
FINISHING AND POLISHING OF AMALGAM
60
RESTORATION, EACH
FIRST DENTAL VISIT � INCLUDES EXAMINATION / CHARTING/ TREATMENT PLAN / COST ESTIMATION AND THE NECESSARY X-RAYS
200
FISSURE SEALANT
120
FISSURE SENTENT / TOOTH+HYGENIST
120
FIXED APPL. FOR BREAKING HABIT
640
FIXED APPLIANCE - HABIT
6,500.00
FIXED PARTIAL DENTURE (FOR ADULT)
400
FIXED SPACE MAINT. BILAT.
1,000.00
FIXED SPACE MAINT. UNILAT. TR.
580
FRACT.MAX.LEFORT II ZYGOM ARCH & FRONT SUSP
8,200.00
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