| Item Number | Description | Schedule Fee |
|---|---|---|
| 88162 | Fissure and/or tooth surface sealing - per tooth (subsequent services) 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. |
$26.10 |
| Total: | $26.10 | |