RSM 5, Attachment 100-4: Dental Fee Schedule
CODE. DENTAL PROCEDURE DESCRIPTION. FEE. Clinical Oral Evaluations D0120 Periodic Oral Evaluation - Established Patient 29.08 D0140 Limited Oral Evaluation - Problem Focused 43.20 D0145 Oral Evaluation Of A Patient Under Three Years Of Age And Counseling With Primary Caregiver 40.00 D0150 Comprehensive Oral Evaluation - New Or Established ... ................
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