| Medicaid:
New York State |
|
|
|
|
| n | Treatment Visits |
||
| n | Amalgam
Restoration 1 Surface 19.00 |
||
| n | Dental
Sealants, per tooth 12.00 |
||
| n | Extraction,
single tooth 25.00 |
||
| n | Root
Canal Therapy, one canal 140.00 |
||
| n | Space
Maintainer, Fixed Unilateral 97.50 |
||
| n | Therapeutic
Pulpotomy 25.00 |
||
| n | Occlusal
Sealant, PCR 25.00 |
||