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- Abutment Crown
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- Amalgam Restorations Permanent 1 Surface
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- Amalgam Restorations Permanent 3 Surfaces
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- Amalgam Restorations Primary 1 Surface
- Amalgam Restorations Primary 2 Surfaces
- Amalgam Restorations Primary 4 or more Surfaces
- Bone Replacement Graft for Ridge Preservation
- Complete Maxillary Denture
- Composite Restoration (Anterior) 1 Surface
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- Composite Restoration (Posterior) 4 Surfaces
- Denture Adjustment
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- Denture Reline, Chairside
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- Orthodontic Treatment for Adolescents
- Orthodontic Treatment for Adults
- Partial Bony Impaction
- Partial Mandibular Denture
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- Porcelain Fused to Noble Metal Crown
- Prophylaxis Child
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- Pulp Cap, Indirect
- Reattach Dental Bridge
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- Simple Extraction with Local Anesthesia
- Soft Tissue Impaction
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- Surgical Removal of Residual Root Tips
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- Tissue Conditioning
- Referral to a Pediatric Dentist
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