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Proposed Fee Changes for FY 2009-10 <br /> Health Department - Dental Services <br /> Description Current Fee Proposed Fee FY 2009-10 Last Revision <br /> Comprehensive Oral Evaluation $50.00 $66.00 2007 <br /> Periodic Oral Evaluation $42.00 $44.00 2007 <br /> Limited Ural Evaluation $42.00 $52.00 2007 <br /> Re-evaluation-limited, problem $28.00 $30.00 2007 <br /> Consultation $52.00 $54.00 2007 <br /> Panoramic Film $67.00 $85.00 2007 <br /> BWX 1 Film $27.00 $28.00 200? <br /> BWX 2 Films $28.00 $30.00 2007 <br /> Bitewings-thre films $31.00 $36.00 2007 <br /> BWX 4 Films $38.00 $46.00 2007 <br /> 1st I ntraoral PA Film $26.00 $27.00 2007 <br /> Additional PA Film $24.00 $25.00 2007 <br /> Intraoral Occulusal Film $27.00 $28.00 2007 <br /> Full Mouth Series w BWX $84.00 $96.00 2007 <br /> Prophy/Child under age 13 $43.00 $45.00 2007 <br /> Prophy/Adult age 13 and up $62.00 $64.00 2007 <br /> Fluoride Varnish (age 13&under) $30.00 $31.00 2007 <br /> Fluoride Varnish (age 13-20) $30.00 $31.00 2007 <br /> Topical Fluoride varnish;therapeutic application for <br /> moderate to high caries risk patients $2g,0D $30.00 2007 <br /> Sealant/NEVVLY ERUPTED TEETH $35.00 $43.00 2007 <br /> Scale/Root Planin 1-3 teeth / $99.00 $103.00 2007 <br /> Scale Root Planing 4> teeth /q $105.00 $111.00 2007 <br /> Full mouth Debridement $90.00 $101.00 2007 <br /> Periodontal Maintenance $78.00 $81.00 2007 <br /> Amal One Surface Prim/Perm $78.00 $89.00 2007 <br /> Amal Two Surface Prim/Perm $89.00 $113.00 2007 <br /> Amal Three Surface Prim/Perm $113.00 $137.00 2007 <br /> Amal Four Surface Prim/Perm $127.00 $156.00 2007 <br /> Resin One Surface Anterior $72.00 $94.00 2007 <br /> Resin Two Surface Anterior $92.00 $118.00 2007 <br /> Resin Three Surface Anterior $113.00 $141.00 2007 <br /> Resin Four Surface Anterior $130.00 $164.00 2007 <br /> Resin Comp. Crown Ant. Prim $164.00 $185.00 2007 <br /> Resin Comp. 1 sur.Post-Prim/Perm $88.00 $11 5.00 2007 <br /> Resin Camp. 2sur.Post--Prim/Perm $129.00 $157.00 2007 <br /> Resin Comp. 3sur.Posterior Perm $165.00 $207.00 2007 <br /> Resin Com .4+sur.Posterior Perm $203.00 $242.00 2007 <br /> Application of Desensitizing Medicament $26.00 $37.00 2007 <br /> Application of Desensitizing Resin for cervical <br /> and/or root surface per tooth $26.00 $52.00 2007 <br /> Pulpotomy $101.00 $119.00 2007 <br /> SSC Primary Tooth $160.00 $201.00 2007 <br /> SSC Permanent Tooth $190.00 $229.00 2007 <br /> Prebacricated Resin Crown $201.00 $235.00 2007 <br /> Prefab.est.coat SSC rim. Tooth $184.00 $214.00 2007 <br /> Sedative Filling $71.00 $74.00 2007 <br /> Palliative Treatment $58.00 $60.00 2007 <br /> Ext. Erupted Tooth Prim/Perm $72.00 $89.00 2007 <br /> Extraction Surgical- 100+ $111.00 $141.00 2007 <br /> Ext. cornal remnants deciduous 1$52.00 $62.00 2007 <br /> 20-"12 <br />