plan Treatment Plan First Name Last Name Today's Visit Consultations Consult- Regular (175) Consult- Major (250) TMJ cosult (350) Other / NotesOther / Notes X-rays Pan CBCT PA's Radiology Report Other / NotesOther / Notes Notes on Today's Treatment Extractions Teeth # for Extractions Basic Supercodes 1SE (extraction with local) 1SEG (extraction with IV) 1SEN (extraction with nitrous) 4FB (extraction of 4 bony impacted teeth with IV) 4PB (extraction of 4 partial impacted teeth with IV) 4SE (extraction of 4 erupted teeth with IV) Graft (site graft) Extraction type Simple (D7140) Surgical (D7210) Partial Extraction Therapy (D7210) Notes on Extractions Dental Implants Site # for Implants Basic Supercodes IML (Implant package with local) IMN (Implant package with nitrous) IMG (Implant package with IV) Additional Implant Related Procedures Surgical Guide (350) Surgical Guide (550) Surgical Guide (other fee) NotesNotes Other Procedures Implant Removal Implants #:Implants #: Notes on Implants Grafting Grafting Type Site bone graft- Minor Site Bone Graft- Major Onlay bone graft Sinus lift Soft tissue grafting PRF (Minor) 350 PRF (Major) 700 Planned grafting Other Procedures Site / Area / Tooth # Procedure Type Biopsy- Minor (675) Biopsy- Major (950) Tooth Exposure (D7280) Tooth Bracket Bonding Other Anesthesia Anesthesia LA N2O IV Time:Time: Prescriptions Prescriptions- Antibiotics PNC 500 AMOX 500 Clindamycin 300 Augmentin 875 Keflex 500 Erythromycin 250 Number of daysNumber of days Here Pharmacy Call-in Prescriptions- Pain Medications T3 Vicodin Percocet No rx- home Ibuprofen / Tylenol OtherOther Here Pharmacy Call-in # of Pills Scheduling How Much Time: Scheduling Notes Financial Type Full Payment; Self Insurance Submit Co-Payment Arrangement Discounted Fee Financing Other Flat Global Fee Offer: Financial-Related Notes Notes / Special Instructions Submit