Primary (deciduous) tooth procedures

RESIN-BASED COMPOSITE RESTORATIONS - DIRECT | RESTORATIVE | January 1, 2026

RESIN-BASED COMPOSITE – ONE SURFACE, POSTERIOR

AMALGAM RESTORATIONS (INCLUDING POLISHING) | January 1, 2026

AMALGAM – ONE SURFACE, PRIMARY OR PERMANENT

OTHER PREVENTIVE SERVICES | January 1, 2026

PREVENTIVE RESIN RESTORATION IN A MODERATE TO HIGH CARIES RISK PATIENT – PERMANENT TOOTH

OTHER RESTORATIVE SERVICES | January 1, 2025

PREFABRICATED PORCELAIN/CERAMIC CROWN – PRIMARY TOOTH

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

EXTRACTION, CORONAL REMNANTS – PRIMARY TOOTH