Basic
✔ Prophylaxis – adult and covered children; once every six months
✔ Topical fluoride – two per twelve months for covered children age 19 and under
✔ Sealants – one per tooth every thirty-six months for covered children age 19 and under
Diagnostic
✔ Oral evaluations; one every six months
✔ Comprehensive periodontal evaluations; one every six months
✔ Bitewing X-rays; one set every twelve months
✔ Vertical bitewings; one set every twelve months
✔ Prophylaxis – adult and covered children; once every six months
✔ Topical fluoride – two per twelve months for covered children age 19 and under
✔ Sealants – one per tooth every thirty-six months for covered children age 19 and under
Diagnostic
✔ Oral evaluations; one every six months
✔ Comprehensive periodontal evaluations; one every six months
✔ Bitewing X-rays; one set every twelve months
✔ Vertical bitewings; one set every twelve months