| 85910-8 | Phys find Teeth+gum | required |
| 85271-5 | Frenum involve site Oral cavity | required |
| 32885-6 | ID {Tooth} Observ | required |
| 32910-2 | Probing depth Tooth Measured | required |
| 32888-0 | Probe site {Tooth}.sulcus | required |
| 34005-9 | Tooth mobility Miller | required |
| 34015-8 | Furc class {Tooth} Glickman | required |
| 32911-0 | Recession Tooth Measured | required |
| 32912-8 | Att level Tooth Calc | required |
| 74046-4 | Suppl info periodontal cond | |
| 86603-8 | Perio attach CDA R1 set | |