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PROCEDURE DESCRIPTION
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YOUR UCR FEE
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PERIODIC ORAL EXAM
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$ .00
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LIMITED ORAL
EXAM=PROBLEM FOCUSED
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$ .00
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COMPREHENSIVE ORAL
EXAM
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$ .00
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PROBLEM FOCUSED
EXAM-DETAILED AND EXTENSIVE
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$ .00
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COMPREHESIVE
PERIODONTAL EXAM
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$ .00
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SCREENING
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$
.00
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ASSESSMENT
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$
.00
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X-RAYS-COMPLETE
SERIES
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$ .00
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X-RAYS- 1 PERIAPICAL
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$ .00
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X-RAYS-2 BITEWINGS
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$ .00
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X-RAYS-4 BITEWINGS
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$ .00
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VERTICAL BITEWING 7
to 8 X-RAYS
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$ .00
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PANORAMIC X-RAY
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$ .00
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CEPHALOMETRIC
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$ .00
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PHOTOS / IMAGES
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$ .00
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PULP VITALITY TESTS
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$ .00
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DIAGNOSTIC MODELS
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$ .00
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BRUSH BIOPSY
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$
.00
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DIAGNODENT TESTS
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$ .00
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PROPHY-ADULT (ROUTINE
CLEANING)
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$ .00
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PROPHY-CHILD
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$ .00
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FLUORIDE
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$ .00
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NUTRITIONAL
COUNSELING
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$ .00
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TOBACCO CESSATION
COUNSELING
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$ .00
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ORAL HYGIENE
INSTRUCTION
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$ .00
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SEALANT /TOOTH
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$ .00
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SPACE
MAINTAINER-FIXED=UNILATERAL
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$ .00
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SPACE
MAINTAINER-FIXED=BILATERAL
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$ .00
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SPACE
MAINTAINER-REMOVABLE-BILATERAL
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$ .00
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AMALGAM-1 SURFACE
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$ .00
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AMALGAM-2 SURFACE
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$ .00
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AMALGAM-3 SURFACE
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$ .00
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AMALGAM-4+ SURFACE
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$ .00
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RESIN-1
SURFACE-ANTERIOR
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$ .00
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RESIN-2
SURFACE-ANTERIOR
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$ .00
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RESIN-3
SURFACE-ANTERIOR
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$ .00
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RESIN-4+SURFACE OR
INCISAL EDGE
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$ .00
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RESIN-1
SURFACE-POSTERIOR
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$ .00
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RESIN-2
SURFACE-POSTERIOR
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$ .00
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RESIN-3
SURFACE-POSTERIOR
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$ .00
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INLAY-1
SURFACE-METALLIC-HN
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$ .00
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INLAY- 2
SURFACE-METALLIC-HN
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$ .00
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INLAY- 3
SURFACE-METALIC-HN
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$ .00
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ONLAY-3
SURFACE-METALLIC-HN
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$ .00
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INLAY- 1
SURFACE-PORCELAIN /CERAMIC
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$ .00
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INLAY- 2
SURFACE-PORCELAIN /CERAMIC
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$ .00
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INLAY- 3
SURFACE-PORCELAIN /CERAMIC
|
$ .00
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ONLAY- 2
SURFACE-PORCELAIN /CERAMIC
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$ .00
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ONLAY- 3
SURFACE-PORCELAIN /CERAMIC
|
$ .00
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ONLAY- 4+
SURFACE-PORCELAIN /CERAMIC
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$ .00
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INLAY-1
SURFACE-COMPOSITE/LAB
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$ .00
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ONLAY-3
SURFACE-COMPOSITE/LAB
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$ .00
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CROWN - RESIN / LAB
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$ .00
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CROWN
PORCELAIN-CERAMIC
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$ .00
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CROWN PORCELAIN/HIGH
NOBLE METAL
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$ .00
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CROWN PORCELAIN/BASE
METAL
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$ .00
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CROWN PORCELAIN/NOBLE
METAL
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$ .00
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CROWN HIGH NOBLE
METAL (GOLD)
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$ .00
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CROWN-TITANIUM
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$ .00
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RECEMENT CROWN
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$ .00
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PREFAB STAINLESS
STEEL CROWN=PRIM.
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$ .00
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PREFAB STAINLESS
STEEL CROWN=ADULT
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$ .00
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PREFAB RESIN CROWN |
$ .00
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SEDATIVE FILLING
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$ .00
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CORE (+PINS)
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$
.00
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POST/PREFAB
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$
.00
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LABIAL
VENEER-RESIN-DIRECT |
$ .00 |
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LABIAL
VENEER-PORCELAIN/LAB
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$ .00
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FIT NEW CROWN TO
EXISTING RPD
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$ .00
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PULP CAP-DIRECT
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$ .00
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PULP CAP-INDIRECT
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$ .00
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PULPOTOMY
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$
.00
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PULP DEBRIDEMENT
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$ .00
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ROOT CANAL-ANTERIOR
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$ .00
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ROOT CANAL-BICUSPID
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$ .00
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ROOT CANAL-MOLAR
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$ .00
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GINGIVECTOMY/QUAD
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$ .00
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GINGIVAL FLAP / QUAD
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$ .00
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OSSEOUS SURGERY/QUAD
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$ .00
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BONE REPLACEMENT
GRAFT
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$ .00
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GUIDED TISSUE
REGENERATION
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$ .00
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PERIODONTAL
SCALING/QUAD
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$ .00
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FULL MOUTH
DEBRIDEMENT
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$ .00
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CHEMOTHERAPY TO
TISSUE/TOOTH
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$ .00
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PERIO MAINTENANCE
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$ .00
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DENTURE-COMPLETE-MAXILLARY
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$ .00
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DENTURE-COMPLETE-MANDIBULAR
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$ .00
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IMMEDIATE
DENTURE-MAXILLARY
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$ .00
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IMMEDIATE
DENTURE-MANDIBULAR
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$ .00
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PARTIAL
DENTURE-MAX/RESIN BASE
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$ .00
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PARTIAL
DENTURE-MAND/RESIN BASE
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$ .00
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PARTIAL
DENTURE-MAX/METAL FRAME
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$ .00
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PARTIAL
DENTURE-MAND/METAL FRAME
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$ .00
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MAX RPD - FLEX BASE
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$ .00
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MAND RPD - FLEX BASE
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$ .00
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DENTURE ADJUSTMENT
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$ .00
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REPAIR COMPLETE
DENTURE BASE
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$ .00
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REPLACE 1 DENTURE
TOOTH
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$ .00
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ADD 1 TOOTH ON
PARTIAL DENTURE
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$ .00
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ADD CLASP ON PARTIAL
DENTURE
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$ .00
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REBASE MAX
DENTURE/LAB
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$ .00
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RELINE MAX
DENTURE/OFFICE
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$ .00
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PRECISION ATTACHMENT
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$ .00
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IMPLANT-
SURGICAL/ENDOSTEAL
|
$ .00
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ABUTMENT- PREFAB
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$ .00
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ABUTMENT SUPPORTED
CERAMIC CROWN
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$ .00
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ABUTMENT SUPPORTED
PORC-HIGH NOBLE CROWN
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$ .00
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ABUTMENT SUPPORTED
RETAINER FOR PORCELAIN/CERAMIC
FPD
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$ .00
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PONTIC/FPD- HIGH
NOBLE METAL
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$ .00
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PONTIC/FPD-
PORCELAIN/HIGH NOBLE
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$ .00
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PONTIC/FPD-
PORCELAIN/BASE METAL
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$ .00
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CROWN/FPD-RETAINER
PORCELAIN/CERAMIC
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$ .00
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CROWN/FPD-RETAINER
PORC/HIGH NOBLE
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$ .00
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CROWN/FPD-RETAINER
PORC/BASE METAL
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$ .00
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CROWN/FPD-RETAINER
HIGH NOBLE
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$ .00
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RECEMENT BRIDGE
(FIXED PARTIAL DENT)
|
$ .00
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PRECISION ATTACHMENT
- FPD |
$ .00
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EXTRACTION - ERUPTED
TOOTH
|
$ .00
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SURGICAL
EXTRACTION-ERUPTED
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$ .00
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SURGICAL
EXTRACTION-SOFT TISSUE
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$ .00
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SURGICAL
EXTRACTION-PARTIAL BONY
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$ .00
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SURGICAL
EXTRACTION-COMPLETE BONY
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$ .00
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SURGICAL EXTRACTION-
ROOT TIP
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$ .00
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ALVEOLOPLASTY-NON
EXTRACTION/QUAD
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$ .00
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OCCLUSAL ORTHOTIC
DEVISE/TMD
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$ .00
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ORTHODONTIC-PRIMARY/LIMITED
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$ .00
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ORTHODONTIC-INTERCEPTIVE/TRANSITION
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$ .00
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ORTHODONTIC-COMPREHENSIVE/TRANSIT
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$ .00
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ORTHODONTIC-COMPREHENSIVE/ADOLES
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$ .00
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ORTHODONTIC-COMPREHENSIVE/ADULT
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$ .00
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ORTHO EVALUATION-PRE
TREATMENT
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$ .00
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ORTHODONTIC RETAINER
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$ .00
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PALLIATIVE TREATMENT
FOR PAIN
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$ .00
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LOCAL ANESTHESIA
|
$ .00
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ANALGESIA=NITROUS
OXIDE
|
$ .00
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ELECTRICAL
ANESTHESIA-TENS
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$ .00
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OFFICE VISIT AFTER
SCHEDULED HOURS
|
$ .00
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DESENSITIZING
MEDICATION
|
$ .00
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OCCLUSAL GUARD
|
$ .00
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ATHLETIC MOUTHGUARD
|
$ .00
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OCCLUSAL ANALYSIS
|
$ .00
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OCCLUSAL
ADJUSTMENT=LIMITED
|
$ .00
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OCCLUSAL
ADJUSTMENT=COMPLETE
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$ .00
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ENAMEL MICROABRASION
|
$ .00
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ODONTOPLASTY
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$
.00
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BLEACH/EXT/ARCH
|
$ .00
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