Filter by:
Code
Type
Clinical Procedure
Unit
16109
- Other, PREVENTION SERVICES
- Finishing Restorations
- Each Addtl Over Four
16201
- Other, PREVENTION SERVICES
- Disking, Interproximal
- One Unit
16202
- Other, PREVENTION SERVICES
- Disking, Interproximal
- Two Units
16203
- Other, PREVENTION SERVICES
- Disking, Interproximal
- Three Units
16301
- Other, PREVENTION SERVICES
- Recontouring - Aesthetic
- One Unit
16309
- Other, PREVENTION SERVICES
- Recontouring - Aesthetic
- Each Additional Unit
16401
- Other, PREVENTION SERVICES
- Recontouring - Functional
- One Unit
16409
- Other, PREVENTION SERVICES
- Recontouring - Functional
- Each Additional Unit
16511
- Adjunctive, PERIODONTICS
- Occlusal Adjustment/Equilibration
- One Unit
16512
- Adjunctive, PERIODONTICS
- Occlusal Adjustment/Equilibration
- Two Units
16513
- Adjunctive, PERIODONTICS
- Occlusal Adjustment/Equilibration
- Three Units
16514
- Adjunctive, PERIODONTICS
- Occlusal Adjustment/Equilibration
- Four Units
16519
- Adjunctive, PERIODONTICS
- Occlusal Adjustment/Equilibration
- Each Addtl Over Four
20111
- RESTORATION
- Caries, Pain Control, Trauma
- First Tooth
20119
- RESTORATION
- Caries, Pain Control, Trauma
- Each Addtl Tooth Same Quadrant
20121
- RESTORATION
- Caries, Pain Control, Trauma
- Plus Band - First Tooth
20129
- RESTORATION
- Caries, Pain Control, Trauma
- Plus Band - EA Tooth Same Quad
20131
- RESTORATION
- Smooth Fract Surf, Trauma Control
- First Tooth
20139
- RESTORATION
- Smooth Fract Surf, Trauma Control
- Each Addtl Tooth - Same Quad
20141
- RESTORATION
- Conj w Perm Rest, Direct, Pulp Cap
- First Tooth