| Item Number | Description | Schedule Fee |
|---|---|---|
| 88572 | Provisional (intermediate/temporary) restoration - per tooth The provisional (intermediate) restoration of a tooth designed to last until the definitive restoration can be constructed or the tooth is removed. This item should only be used where the provisional (intermediate) restoration is not an intrinsic part of treatment. It does not include provisional (temporary) sealing of the access cavity during endodontic treatment or during construction of indirect restorations. |
$55.20 |
| Total: | $55.20 | |