Filter by:
Code
Type
Clinical Procedure
Unit
08012
- DIAGNOSTIC
- Remote assessment
- Remote Assessment of chief Complaint, Two Unit
08019
- DIAGNOSTIC
- Remote assessment
- Each additional unit over two, Remote Assessment of chief Complaint
11101
- PREVENTION SERVICES
- Polishing
- One Unit
11102
- PREVENTION SERVICES
- Polishing
- Two Units
11107
- PREVENTION SERVICES
- Polishing
- 1/2 Unit
11109
- PREVENTION SERVICES
- Polishing
- Each Additional Unit Over 2
11111
- PREVENTION SERVICES
- Scaling
- One Unit
11112
- PREVENTION SERVICES
- Scaling
- Two Units
11113
- PREVENTION SERVICES
- Scaling
- Three Units
11114
- PREVENTION SERVICES
- Scaling
- Four Units
11115
- PREVENTION SERVICES
- Scaling
- Five Units
11116
- PREVENTION SERVICES
- Scaling
- Six Units
11117
- PREVENTION SERVICES
- Scaling
- 1/2 Unit
11119
- PREVENTION SERVICES
- Scaling
- Each Additional Unit Over 6
12101
- PREVENTION SERVICES
- Fluoride Treatments(whole mouth)
- Foam, Gel or Rinse
12102
- PREVENTION SERVICES
- Fluoride Treatments(whole mouth)
- Self-Administered Brush-In
12103
- PREVENTION SERVICES
- Fluoride Treatments(whole mouth)
- Varnish
12601
- PREVENTION SERVICES
- Custom Appliances
- Home Application Maxillary Arch
12602
- PREVENTION SERVICES
- Custom Appliances
- Home Application Mandibular Arch
13101
- Other, PREVENTION SERVICES
- Nutritional Counselling
- One Unit