Diagnostic Procedures
Pandemic Related
Preventive Procedures
Maxillofacial Surgery
Complete Denture
100

Periodic Oral Evaluation

D0120

100

Pfizer 1st Dose

D1701

100

Prophylaxis Adult

D1110

100

Nasal Prosthesis

D5913

100

Complete denture maxillary

D5110

200

Limited Oral Evaluation- Problem Focused

D0140

200

Pfizer 2nd Dose

D1702

200

Prophylaxis Child

D1120

200

Auricula Prosthesis

D5914

200

Complete Denture Mandibular

D5120

300
Comprehensive Oral Evaluation

D0150

300

Jansen Vaccine

D1707

300

Topical Application of fluoride varnish

D1206

300

Facial Prosthesis

D5919

300

Partial Denture Maxillary

D5225

400

Comprehensive Periodontal Evaluation

D0180

400

Moderna 1st dose

D1703

400

Topical Application of Fluoride- excluding varnish

D1208

400

Ocular Prosthesis

D5916

400

Partial Denture Mandibular

D5226

500
Comprehensive Periodontal Eval (New and Established)

D0180

500

AstraZeneca 2nd dose

D1706

500

Oral Hygiene Instructions

D1330

500

Orbital Prosthesis

D5915

500

Reline Maxillary

D5730

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