Crowns, Metal three quarter Cast Metal, Complicated

Crowns, three quarter, Cast Metal, with Direct Tooth Colored Corner

CROWNS MADE TO AN EXISTING PARTIAL DENTURE CLASP (additional to crown)

One crown

Each additional crown

COPINGS, METAL/PLASTIC, TRANSFER (thimble type)

Coping, Metal/Acrylic, Transfer (thimble), as a separate procedure

Coping, Metal/Acrylic, Transfer (thimble) as a Separate Procedure

Coping, Metal/Acrylic, Transfer (thimble) Concurrent with Impression for Crown

Coping, Metal/Acrylic, Transfer (thimble) Concurrent with Impression for Crown

VENEERS, LABORATORY PROCESSED

Veneers, Acrylic/Composite/Compomer, Bonded

Veneers, Porcelain/Ceramic/Polymer Glass, Bonded

Repairs of direct and indirect restorations

Repairs, (single units only, does not include removal and recementation)

Repairs, Acrylic/Composite/Compomer, Direct

Repairs, Inlays, Onlays or Crowns, Porcelain/Ceramic/Polymer Glass, Porcelain/Ceramic/Polymer
Glass/Fused to Metal base (single units)

Repairs, Inlays, Onlays or Crowns, Porcelain/Ceramic/Polymer Glass,
Porcelain/Ceramic/Polymer Glass/Fused to Metal base, Direct

Repairs, Inlays, Onlays or Crowns, Porcelain/Ceramic/Polymer Glass, Porcelain/Ceramic/Polymer
Glass/Fused to Metal base, Indirect

RECONTOURING OF EXISTING CROWNS per tooth

One unit of time

Each additional unit of time

RESTORATIVE PROCEDURES, OVERDENTURES

RESTORATIVE PROCEDURES, OVERDENTURES, DIRECT

Natural Tooth Preparation, Placement of Pulp Chamber Restoration (amalgam or composite) and Fluoride Application Endodontically Treated Tooth

Natural Tooth Preparation and Fluoride Application, Vital Tooth

Pre-fabricated Attachment, as an Internal/External Overdenture Retentive Device, Direct to a Natural
Tooth (used with the appropriate denture code) per tooth

Implant-supported Prefabricated Attachment as an Overdenture Retentive Device, Direct

RESTORATIVE PROCEDURES, OVERDENTURES, INDIRECT

Coping Crowns, Cast Metal, No Attachments, Indirect

Coping Crown, Cast Metal, No Attachments, Indirect

Coping Crown, Cast Metal, No Attachments, Implant-supported, Indirect

Coping Crown, Cast Metal with Cast Metal Retentive Post, No Attachments

Coping Crown, Cast Metal, with Attachments, Indirect

Coping Crown, Metal Cast, with Attachment, Indirect

Coping Crown, Cast Metal, Implant-supported with Attachment

Coping Crown, Cast Metal with Cast Metal Retentive Post, with Attachment

RESTORATIVE SERVICES, OTHER

RECEMENTATION/REBONDING, INLAYS/ONLAYS/ CROWNS/VENEERS/POSTS/ NATURAL TOOTH
FRAGMENTS (single units only) (+ L and/or +E where laboratory charges or expenses are incurred
during repair of the unit)

One unit of time