WebAug 30, 2024 · D1351 – Sealant – Per Tooth 5. Providers must include Caries Risk Assessment code (D0601, D0602 or D0603) and documentation on claim form for payment to be made. When submitting school services for reimburse claim must contain one of the Caries Risk Assessment Codes (D0601 – D0603) to receive reimbursement. WebJul 21, 2001 · D1351 Sealant – Per Tooth 33.23 D1352 . Preventive Resin Restoration in a Moderate to High Caries Risk Patient – Permanent Tooth 33.23 . ... D5630 Repair/Replace Broken Clasp – per Tooth 63.00 D5640 Replace Broken Teeth - Per Tooth 20.00 D5650 Add Tooth to Existing Partial Denture 57.00 D5660 Add Clasp To Existing Partial …
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WebApplication of a caries preventive medicament (D1355) is one of several preventive services delivered to a patient based on the dentist’s diagnosis of the patient’s clinical condition. … WebD1351 Sealants, per tooth $0 $76 $76 SPACE MAINTAINERS D1510 Fixed, unilateral $0 $365 $365 D1520 Removable, unilateral $0 $402 $402. Benefits Typical Charge* Typical. Description. Savings. TREATMENT AND THERAPY. AMALGAM D2140 One surface, permanent or primary tooth $0 $180 $50 D2150 Two surfaces, permanent or camping near jackson tn
GENERAL DENTIST FEE SCHEDULE Category CDT Code …
WebD1351 Sealant, per tooth $69 $26 62% D1510 Space maintainer, fixed, unilateral $361 $210 42% D1515 Space maintainer, fixed, bilateral $478 $315 34% D1550 Recementation of space maintainer $99 $58 41% D1555 Removal of space maintainer $97 $58 40% Restorative Services (Performed by a General Dentist) ADA WebAug 30, 2024 · D1351 – Sealant – Per Tooth ; 5. Providers must include . Carries Risk Assessment Code (D0601, D0602 or D0603) and documentation on claim form for payment to be made. When submitting school services for reimburse claim must contain one of the Caries Risk Assessment Codes (D0601 – D0603) to receive reimbursement. No Caries … WebD1351 SEALANT - PER TOOTH (AGES 5-20) $24.38 n/c D1354 SILVER DIAMINE FLUROIDE per tooth 12.00 per tooth. Up to two times per tooth within six months if clinically indicated $12.00 $12.00 Effective date 01/01/2024 D1510 SPACE MAINTAINER-FIXED UNILATERAL $169.00 n/c D1516 FIXED BILAT SPACE MAINT, MAX $250.00 n/c fir 全称