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OTHER PREVENTIVE SERVICES | January 1, 2025

CARIES PREVENTIVE MEDICAMENT APPLICATION – PER TOOTH

EXTRACTIONS (INCLUDES LOCAL ANESTHESIA, SUTURING, IF NEEDED, AND ROUTINE POSTOPERATIVE CARE) | January 1, 2025

EXTRACTION, CORONAL REMNANTS – PRIMARY TOOTH

CROWNS - SINGLE RESTORATIONS ONLY | January 1, 2025

CROWN – RESIN-BASED COMPOSITE (INDIRECT)

CROWNS - SINGLE RESTORATIONS ONLY | January 1, 2025

CROWN – 3/4 RESIN-BASED COMPOSITE (INDIRECT)

INLAY/ONLAY RESTORATIONS | January 1, 2025

ONLAY – RESIN-BASED COMPOSITE – FOUR OR MORE SURFACES