| Item Number | Description | Schedule Fee |
|---|---|---|
| 57963 | Orthopantomography for diagnosis or management (or both) of any of the following conditions, if the signs and symptoms of the condition is present:(a) impacted teeth;(b) caries;(c) periodontal pathology;(d) periapical pathology (R) |
$54.50 |
| Total: | $54.50 | |