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<br />,--- <br /> <br />02651 <br /> <br />02652 <br /> <br />---I <br /> <br />------ <br /> <br />Inlay -- composite/resin -- two surfaces, <br />processed) <br />Inlay -- composite/resin -- three surfaces, <br />processed) <br /> <br />(labora tory <br /> <br />(laboratory <br /> <br />Crowns -- single restoration only <br /> <br />02710 <br />02740 <br />02750 <br />02751 <br />02752 <br />02790 <br />02791 <br />02792 <br />02810 <br /> <br />Crown -- resin (laboratory) <br />Crown -- porcelain/ceramic substrate <br />Crown -- porcelain fused to high noble metal <br />Crown -- porcelain fused to predominantly base <br />Crown -- porcelain fused to noble metal <br />Crown -- full cast high no~le metal <br />Crown -- full cast predominantly base metal <br />Crown -- full cast noble metal <br />Crown -- 3/4 cast metallic <br /> <br />metal <br /> <br />Other restorative services <br /> <br />02910 <br />02920 <br />02930 <br />02931 <br />02932 <br />02933 <br />02950 <br />02951 <br />02952 <br />02954 <br />02960 <br />02961 <br />02962 <br />02980 <br /> <br />Pulp capping <br /> <br />03110 <br />03120 <br /> <br />Recement inlay <br />Recement crown <br />Prefabricated stainless steel crown -- primary tooth <br />Prefabricated stainless steel crown -- permanent tooth <br />Prefabricated resin crown <br />Prefabricated stainless steel crown with resin window <br />Crown buildup (substructure), including any pins <br />pin retention -- per tooth, in addition to restoration <br />Cast post and core in addition to crown <br />Prefabricated post and core in addition to crown <br />Labial veneer (laminate) -- chairside <br />Labial veneer (resin laminate) -- laboratory <br />Labial veneer (porcelain laminate) -- laboratory <br />Crown repair, by report <br /> <br />Pulp cap -- direct (excluding final restoration) <br />Pulp cap -- indirect (excluding final restoration) <br /> <br />3 <br /> <br />- -------- <br /> <br />-- <br />----- <br />--- <br />- ------- <br />--______n --- <br />