Diagnostic & X-Rays
Comprehensive Exam (New Patient, initial visit)
100%
Periodic Exam (2 per year)
100%
Limited Oral Exam, Problem Focused (1 per year)
100%
Intraoral - Complete Series or Panorex
100%
Intraoral - Periapical, First Film
100%
Intraoral - Periapical, Each Additional Film
100%
Intraoral - Occlusal Film
100%
Bitewings (yearly, as needed)
100%
Preventive
Child Prophylaxis (cleaning) (2 per year)
100% (Additional Visits 15%)
Adult Prophylaxis (cleaning) (2 per year)
100% (Additional Visits 15%)
--OR--
Adult Periodontal Maintenance (2 per year)
100% (Additional Visits 15%)
Fluoride (2 per year, no age limit)
100%
Sealants
50%