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FY 2009-10 Proposed Changes to the County Fee Schedule 44 <br />Topical Fluoride vamish;therapeufic <br />app8catfon for moderete ro high $2g,Op $30.00 <br />2008 <br />SealanUNEWLY ERUPTED TEETH $35.00 $43.00 2008 <br />Scale/Root Planln 1-3 teeth p/ $99.00 $103,00 2008 <br />Sete Rant Planin 4~ teeth / 8105.00 $111.00 2008 <br />Full mouth Debridement 590.00 $101.00 2008 <br />Periodontal Mafntenarrce 578.00 $81.00 <br />Aural One Surface Pdml Perm $78.00 889.00 <br />Aural Two Surface Print Pemt 889.00 $173.00 2008 <br />2~8 <br />2008 <br />Aural Three Surface PrimlPern $113.00 $137.00 2008 <br />Aural Four Surface PrimlPerm $127.00 $156.00 <br />Resin One Surface Anterior $7200 $94.00 <br />Resin Two Surface Antedor $92.00 $118.00 2008 <br />2008 <br />2008 <br />Resin Three Surface Anteror $113.00 $141.00 2008 <br />Resin Four Surface Anterior 8130.00 $164.00 2008 <br />Resin Com .Crown Ant Prim $184.00 $185.00 2008 <br />Resin Com . 1sur.Post-PrimlPern $88.00 $115.00 2008 <br />Resin Com . 2sur.Post Prim/Penn <br />Resin Com . 3sur.Posterbr Perm <br />Resin Com .4+sur.Posterior Perm $129.00 <br />5185.00 <br />$203.00 $157.00 <br />$207.00 <br />824200 2008 <br />2008 <br />2008 <br />Application of Desensitizing <br />Medicament <br />$26.00 <br />$37.00 <br />2008 <br />Application of Desensitizing Resin for <br />cervfgl and/or root surface er tooih <br />$26.00 <br />$52.00 <br />2008 <br />Pul otom $101.00 $119.00 2008 <br />SSC Prima Tooth $160.00 8201.00 2008 <br />SSC Permanent Tooth $190.00 8229.00 2008 <br />Prebacricated Resin Crown $201.00 $235.00 2008 <br />Prefab.estcoat SSC rim. Tooth <br />Sedative Filll <br />Palliative Treatment <br />Fxt. Eru ted Tooth PrimlPerm <br />Extraction Su ipl -100+ $184.00 <br />$71.00 <br />$58.00 <br />$72.00 <br />$111.00 $214.00 <br />$74.00 <br />$60.00 <br />$89.00 <br />5141.00 2008 <br />2008 <br />2008 <br />ZDOB <br />2008 <br />Ext. cornal remnants dedduous $52.00 $6200 2008 <br />Alveo las extractions ! uad. $108.00 $118.00 2008 <br />Alvetoptasty in canjunctfon with <br />extreGion 1-3 teeth r quadrant <br />$104.00 <br />$11 B.~ <br />2008 <br />ANebplasty not in conjunction with <br />extrection 4 or more tooth spaces per <br />uadrant <br /> <br />$182.00 <br /> <br />$189.00 <br /> <br />2008 <br />Alveloplasty not in conjunction with <br />extreclion 1-3 tooth spaces per <br />quadrant <br /> <br />$156.00 <br /> <br />$162.00 <br /> <br />2008 <br />Recement Crown NOT cov. b MA $55.00 $57.00 2008 <br />Stud Models $50.00 $53.00 2008 <br />I & D Misr Su $168.00 $186.00 2008 <br />Occuisal Ad usiment Limited 883.E $86.00 2008 <br />Fractured Tooth Txt $67.00 $70.00 2008 <br />Pul Ca direct ex . P MED $44.00 848.00 2008 <br />Pu Ca indirect n e osed $44.00 $46.00 2008 <br />Bio oralTlssue $144.00 $151.00 Zoos <br />Pin RetentioNtooth $29.00 <br />Band & Loo Quadrent Deliver 20912 $230.00 <br />Fixed Bilateral Deliver 419/30 5463.00 $30.00 <br />$264.00 <br />$482.00 2008 <br />2008 <br />2008 <br />Occlusal guard, by report minimize <br />bnncism $274/951ab <br />$285.00 <br />$296.00 ~ <br />2008 <br />Fabrication of Athletic Mo uard $104.00 $108.00 2008 <br />Root Canal Thera Anterior $416.00 433.00 2008 <br />Root Canal Thera Bicus id $494.00 514.E 2008 <br />Root Canal Thera Molar $624.00 649.00 2008 <br /> <br />Flat Fees Mouthguard Project 2008 <br />2008 <br />Flat Fee Fabrication of Athletic <br />Mouthguard Projects <br />$15.00 <br />$17.00 <br />2008 <br />2of7 <br />