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ADJUNCTIVE GENERAL SERVICES | ANESTHESIA | January 1, 2026

ADMINISTRATION OF DEEP SEDATION/GENERAL ANESTHESIA – EACH SUBSEQUENT 15 MINUTE INCREMENT, OR ANY PORTION THEREOF

ADJUNCTIVE GENERAL SERVICES | ANESTHESIA | January 1, 2026

ADMINISTRATION OF DEEP SEDATION/GENERAL ANESTHESIA – FIRST 15 MINUTE INCREMENT, OR ANY PORTION THEREOF

PERIODONTICS | SURGICAL SERVICES (INCLUDING USUAL POSTOPERATIVE CARE) | January 1, 2026

BONE REPLACEMENT GRAFT – RETAINED NATURAL TOOTH- FIRST SITE IN QUADRANT

PERIODONTICS | SURGICAL SERVICES (INCLUDING USUAL POSTOPERATIVE CARE) | January 1, 2026

BONE REPLACEMENT GRAFT- RETAINED NATURAL TOOTH- EACH ADDITIONAL SITE IN QUADRANT

DENTAL PROPHYLAXIS | PREVENTIVE | January 1, 2026

PROPHYLAXIS – ADULT