Adjust full denture, lower
Adjust full denture, upper
Aesthetic and functional test
Application of desensitizing medicaments
Bone graft with mesh or membrane
Coarse Scraping with Cavitron
Delivery of Dental Prostheses
Dental consultation with x-ray and cleaning
Dental implant, per tooth
Dental x-rays (fin, occlusal, periapical)
Diastema closure with resins
Extraction of wisdom teeth
Extraction of wisdom tooth (nonsurgical)
Extraction of wisdom tooth (surgical)
Fabrication of mouthguard
Filling (Permanent Tooth)
Gingivectomy or gingivoplasty, per tooth
Impacted tooth extraction
Incision and drainage of abscess, intraoral tissue
Initial Physical Therapy Evaluation
¢30000.00
Inlay, porcelain/ceramic, 1 surface
Local anesthesia not in conjunction with operative or surgical procedures
Opening of Clinical History
Orthodontic records (diagnostic cast, x-rays, photographs)
Orthodontic traction of impacted part
Periodontal maintenance (non-invasive)
Periodontal scaling & root planing, per quadrant
Permanent tooth extraction
Porcelain crown, per tooth
Reevaluation Consultation
Root canal therapy, anterior, excluding final restoration
Root canal therapy, biradicular
Root canal therapy, molar, excluding final restoration
Temporal tooth extraction
Temporary Restorations (glass ionomer, zinc oxide, basic restorations)
Tooth bleaching without lamp (clinical)