Application of desensitizing medicaments
Dental cleaning with fluoride
Dental x-rays (fin, occlusal, periapical)
Diastema closure with resins
Diastema closures with resins
Drainage of abscess, intraoral
Fabrication of mouthguard
Incision and drainage of abscess, intraoral tissue
Inlay, porcelain/ceramic, 1 surface
Limited oral evaluation
¢30000.00
Local anesthesia not in conjunction with operative or surgical procedures
Periodontal maintenance (non-invasive)
Periodontal scaling & root planing, per quadrant
Porcelain veener, per tooth
Root canal therapy, anterior, excluding final restoration
Root canal therapy, biradicular
Root canal therapy, molar, excluding final restoration
Temporary Restorations (glass ionomer, zinc oxide, basic restorations)
Tooth bleaching without lamp (clinical)
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Thu Apr 25Fri Apr 26Sat Apr 27
