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

REMOVAL OF IMPACTED TOOTH – COMPLETELY BONY, WITH UNUSUAL SURGICAL COMPLICATIONS

CROWNS - SINGLE RESTORATIONS ONLY | January 1, 2025

INTERIM CROWN – FURTHER TREATMENT OR COMPLETION OF DIAGNOSIS NECESSARY PRIOR TO FINAL IMPRESSION

OTHER RESTORATIVE SERVICES | January 1, 2025

REATTACHMENT OF TOOTH FRAGMENT, INCISAL EDGE OR CUSP

CROWNS - SINGLE RESTORATIONS ONLY | January 1, 2025

CROWN – TITANIUM AND TITANIUM ALLOYS

TOPICAL FLUORIDE TREATMENT (OFFICE PROCEDURE) | January 1, 2025

TOPICAL APPLICATION OF FLUORIDE- EXCLUDING VARNISH