Common Codes

Dollar Amount

100

$50

Nitrous Gas

200

$113

Prophy

300

$170

Perio maintenance 

400

$147

Recement crown 

500

$1,092

Custom abutment for implant

CDT Codes

100

D1110

Prophy

200

D0274

4 Bitewings

300

D0330

Pano

400

D2740

Porcelain crown 

500

D6058

abutment supported implant crown

Name

100

Periodic Oral Evaluation 

D0120

200

Comprehensive Oral Evaluation 

D0150

300

Fluoride Varnish

D1206

400

Buildup/Core

D2950

500

Application of hydroxyapatite medicine

D2991

Dollar Amount

100

$39

First PA

200

$99

Application of caries arrest medicine

300

$289

Two surface posterior composite fill

400

$1,410

Porcelain crown

500

$248

SRP 1-3 teeth

CDT Codes

100

D9230

Nitrous Gas

200

D0140

Limited oral evaluation 

300

D0230

Sequential PAs

400

D4341

SRP 4+ teeth

500

D6057

custom abutment for implant