
37 Surgeries and Treatments

state plans

Single X-Ray (D0220)

RPS (full quad) (D4341)

RPS (1-3 teeth) (D4342)

Root Canal Treatment

Porcelain to Fused High Noble (D2750)

Porcelain Fused to Base Metal (D2751)

Perio Maintenance (D4910)

Oral Irrigation (Per Quad) (D4999)

Office Co-Pay
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