Comprehensive Periodontal Examination

Full mouth comprehensive perio recording
six visits - one form

The Comprehensive Periodontal Examination form records specific "soft tissue" information. If the initial Periodontal Screening (C-203R) results in Code 3 in two sextants or Code 4 in one sextant, a full mouth Comprehensive Periodontal Examination should be completed by the general dentist or the patient should be referred to a specialist.

This form is used to record initial examination findings and five additional visits. Five sequential clinical parameters - probing, bleeding, recession, mobility and furcations - can be documented.

Photocopies of the form, completed for your patient, can be used to provide documentation for insurance needs and as communication between the general dentist and the periodontist. It replaces a time consuming written narrative.

  • 6 Continuous Care appointments - all on one form
  • 6 full mouth recordings at a glance
  • Photocopy completed form for insurance documentation
  • 5 clinical parameters and 15 additional periodontal factors may be recorded
  • Unique design - position of number codes for recession / mobility corresponds to exam dates
C-103R Comprehensive Periodontal Exam
$18.00 / 200 $34.00 / 400
$64.00 / 800 $120.00 / 1600



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