eClaim

Dental items requiring tooth ID

Item Number

Treatment Type/Description

Essential Dental

*161

Fissure sealing – per tooth

General Dental

*116

Enamel micro abrasion

*511

Metallic restoration - one surface

*512

Metallic restoration - two surface

*513

Metallic restoration - three surface

*514

Metallic restoration - four surface

*515

Metallic restoration - five surface

*521

Adhesive restoration - 1 surface

*522

Adhesive restoration - 2 surface

*523

Adhesive restoration - 3 surface

*524

Adhesive restoration - 4 surface

*525

Adhesive restoration - 5 surface

*531

Adhesive restoration - 1 surface - posterior tooth

*532

Adhesive restoration - 2 surface - posterior tooth

*533

Adhesive restoration - 3 surface - posterior tooth

*534

Adhesive restoration - 4 surface - posterior tooth

*535

Adhesive restoration - 5 surface - posterior tooth

General Dental plus

*171

Odontoplasty - per tooth

*572

Temporary restoration

*574

Temporary restoration using metal band

*575

Pin retention – per pin

Surgical Dental

*311

Removal of a tooth or part(s) thereof

*314

Sectional removal of a tooth

*322

Surgical removal of tooth

*323

Surgical removal of tooth

*324

Surgical removal of tooth