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DENTAL DEPARTMENT PRIVILEGE REQUEST. Dental Privilege Code Dental Procedure Requested Approved Diagnostic 00110 Initial Oral Examination 00120 Periodic Oral Examination 00130 Emergency Oral Examination 00170 Periodontal Examination 00460 Pulp Vitality Tests 00470 Diagnostic Casts 09110 Palliative (emergency) Treatment of Dental Pain-minor procedures 09430 Office Visit for … ................
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