| Item Number | Description | Schedule Fee |
|---|---|---|
| 88161 | Fissure and/or tooth surface sealing - per tooth (first four services on a day) Sealing of non-carious pits, fissures, smooth surfaces or cracks in a tooth with an adhesive material. Any preparation prior to application of the sealant is included in this item number. |
$52.15 |
| Total: | $52.15 | |