ADJUNCTIVE GENERAL SERVICES - Page 4

ADJUNCTIVE GENERAL SERVICES | ANESTHESIA | January 1, 2026

ADMINISTRATION OF MODERATE SEDATION – NON-INTRAVENOUS PARENTERAL – FIRST 15 MINUTE INCREMENT, OR ANY PORTION THEREOF

ADJUNCTIVE GENERAL SERVICES | ANESTHESIA | January 1, 2026

IN-OFFICE ADMINISTRATION OF MINIMAL SEDATION – SINGLE DRUG – ENTERAL

CROWNS - SINGLE RESTORATIONS ONLY | PROFESSIONAL CONSULTATION | January 1, 2025

CROWN – FULL CAST PREDOMINANTLY BASE METAL

CROWNS - SINGLE RESTORATIONS ONLY | PROFESSIONAL CONSULTATION | January 1, 2025

CROWN – PORCELAIN FUSED TO PREDOMINANTLY BASE METAL

MISCELLANEOUS SERVICES | January 1, 2025

EXTERNAL BLEACHING – PER TOOTH