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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | DECIDIOUS REST.G.I.C. 1 SURF.-LARGE | 97551-01[466] | 320091 | 2002385 | 320 | ||
0 | DECIDIOUS REST.G.I.C. 1 SURF.-SMALL | 97551-01[466] | 320092 | 2002385 | 190 | ||
0 | DECIDIOUS REST.G.I.C. 2 SURF.-LARGE | 97552-01[466] | 320093 | 2002385 | 300 | ||
0 | DECIDIOUS REST.G.I.C. 2 SURF.-SMALL | 97552-01[466] | 320094 | 2002385 | 260 | ||
0 | DENSENSITIZATION/ TOOTH | 97165-01[455] | 320095 | 2001351 | 240 | ||
3 | DENTAL TREATMENT UNDER G.A (A)1 | 320096 | Y | 4,158.00 | |||
0 | DISTAL SHOE SPACE MAINTAINER | 320097 | 10015 | 1,000.00 | |||
0 | DISTRACTION OSTEOGENESIS ALVEOLAR BONE | 320098 | 2,960.00 | ||||
0 | DISTRACTION OSTEOGENESIS ALVEOLAR BONE1 DAY PACKAGE | 320099 | 4,000.00 | ||||
0 | DRESSING EXTRACTION SOCKET | 97455-00[464] | 320100 | 2003426 | 190 | ||
0 | EXCISION OF GINGIVA FOR RETAINED TOOTH/IMPLANT EACH ADDITIONAL TOOTH/IMPLANT | 320101 | 41820 | 160 | |||
0 | EXCISION OF PERICORONAL GINGIVA (FOR RETAINED TOOTH/IMPLANT) PER TOOTH/IMPLANT LA | 320102 | 2007971 | 400 |
DECIDIOUS REST.G.I.C. 1 SURF.-LARGE
320
DECIDIOUS REST.G.I.C. 1 SURF.-SMALL
190
DECIDIOUS REST.G.I.C. 2 SURF.-LARGE
300
DECIDIOUS REST.G.I.C. 2 SURF.-SMALL
260
DENSENSITIZATION/ TOOTH
240
DENTAL TREATMENT UNDER G.A (A)1
4,158.00
DISTAL SHOE SPACE MAINTAINER
1,000.00
DISTRACTION OSTEOGENESIS ALVEOLAR BONE
2,960.00
DISTRACTION OSTEOGENESIS ALVEOLAR BONE1 DAY PACKAGE
4,000.00
DRESSING EXTRACTION SOCKET
190
EXCISION OF GINGIVA FOR RETAINED TOOTH/IMPLANT EACH ADDITIONAL TOOTH/IMPLANT
160
EXCISION OF PERICORONAL GINGIVA (FOR RETAINED TOOTH/IMPLANT) PER TOOTH/IMPLANT LA
400
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