6.6 Dental X-rays or Lab Work Required for Restoration

(Procedure codes 11300-03, 11300-04, 11300-05, 11300-06, 11300-07, 11300-08 11300-09, 11300-10)

Allowable fees for Dental Procedures

• Initial oral examination $60.00

• Radiographs

  • Complete intraoral, includes bitewings $99.00

  • Periapical intraoral, first film $22.00

  • Periapical intraoral, each additional $22.00

  • Occlusal intraoral $22.00

  • Panoramic film $99.00

  • Single Bitewings, first $22.00

  • Bitewings, two films $33.00

  • Bitewings, four films $52.00