N - Page 2

REDUCTION OF DISLOCATION AND MANAGEMENT OF OTHER TEMPOROMANDIBULAR JOINT DYSFUNCTIONS | January 1, 2025

OCCLUSAL ORTHOTIC DEVICE, BY REPORT

PARTIAL DENTURES (INCLUDING ROUTINE POST-DELIVERY CARE) | January 1, 2025

REMOVABLE UNILATERAL PARTIAL DENTURE – ONE PIECE CAST METAL (INCLUDING RETENTIVE/CLASPSING MATERIALS, RESTS, AND TEETH), MANDIBULAR

PARTIAL DENTURES (INCLUDING ROUTINE POST-DELIVERY CARE) | January 1, 2025

REMOVABLE UNILATERAL PARTIAL DENTURE – ONE PIECE CAST METAL (INCLUDING RETENTIVE/CLASPING MATERIALS, RESTS, AND TEETH), MAXILLARY

OTHER RESTORATIVE SERVICES | RESTORATIVE | January 1, 2025

EXCAVATION OF A TOOTH RESULTING IN THE DETERMINATION OF NON-RESTORABILITY

MISCELLANEOUS SERVICES | September 16, 2024

OCCLUSAL GUARD ADJUSTMENT