Dental cleaning with fluoride
Dental implant, per tooth
Dental x-rays (fin, occlusal, periapical)
Diastema closure with resins
Diastema closures with resins
Drainage of abscess, intraoral
Fabrication of mouthguard
Immediate dental implants hybrid prosthesis
Impacted tooth extraction
Implant abutment supported bridge retainer crown, full coverage, all metal with high gold content
Implant abutment supported bridge retainer crown, porcelain fused to metal with high gold content
Implant abutment supported bridge retainer crown, porcelain fused to metal with moderate gold content
Implant abutment supported bridge retainer crown, porcelain fused to metal with no gold content
Implant abutment supported porcelain/ceramic bridge retainer crown
Implant supported bridge retainer crown, porcelain fused to titanium, titanium alloy, or metal
Implant supported bridge retainer crown, porcelain/ceramic
Incision and drainage of abscess, intraoral tissue
Inlay, porcelain/ceramic, 1 surface
Local anesthesia not in conjunction with operative or surgical procedures
Orthodontic records (diagnostic cast, x-rays, photographs)
Periodontal scaling & root planing, per quadrant
Permanent tooth extraction
Porcelain crown, per tooth
Porcelain veener, per tooth
Teeth Whitening with Lamp (in the clinic)
Temporary Restorations (glass ionomer, zinc oxide, basic restorations)
Tooth bleaching without lamp (clinical)