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Dental Health Fees 4 2 <br /> Fees have, been reviewed and approved by the Board of Health <br /> All Fees will be administered on a Sliding Scale Fee. Fees shown hcre are at 10057c. <br /> PRESENT <br /> 100% 100% <br /> FEE (1) FEE (2) <br /> ,ACTION <br /> Permanent Tooth 35 45 <br /> Primary Tooth 25 35 <br /> Each Additional Tooth 35 40 <br /> Surgical 65 80 <br /> FLORIDE <br /> Topical 12 15 <br /> MISCELLANEOUS <br /> Occulsal Equilibration 15 55 <br /> Fractured Tooth 50 60 <br /> I & D Minor Surgery 25 40 <br /> Oral Hygiene Instructions 15 20 <br /> Palliative Treatment 20 35 <br /> Pin Retention, Per Tooth 10 20 <br /> Studv Model 30 35 <br /> Treatment Restoration 25 40 <br /> PROPHYLAXIS (cleaning) <br /> Adult 30 40 <br /> Child 20 20 <br /> PULP <br /> Pulp Cap Direct 40 40 <br /> ''?ulp Cap Indirect 40 40 <br /> 1 <br /> i`.. ..:;: 'ulpotomy 50 75 <br /> RECEMENT <br /> Recement 25 40 <br /> SCALING <br /> Gross Scaling 35 60 <br /> Periodontal Scale Root Plane <br /> Per Quadrant 40 70 <br /> SEALANTS <br /> Per Quadrant 30 40 <br /> Per Tooth 12 20 <br /> !SPACE MAINTAINERS <br /> Band & Loop, Per Quadrant 75 105 <br /> Distal Shoe, Per Quadrant 85 1 120 <br /> Fixed Habit Appl 125 250 <br /> Lingual Arch . 150 210 <br /> Removable Bilateral Appl 150 235 <br /> Removable Habit Appl 125 250 <br /> (1) Present Fees: Fee currently charged to 100% pay patients at Orange County Dental Clinic. <br /> (2) Recommended 100% Fee: Recommended new fees. <br /> ** NOTE** <br /> 'Minimum Charge of$15 per Visit <br />