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04/17/2008 <br />Alveloplasty not in conjunction with extraction 1-3 tooth spaces per <br />quadrant $150 $156 <br />Recement Crown NOT cov, by MA $53 $55 <br />Study Models $48 $50 <br />I & D Minor Surgery $162 $168 <br />Occulsal Adjustment Limited $80 $83 <br />Fractured Tooth Txt. $64 $67 <br />Pulp Cap-direct exp. Pulp MED $42 $44 <br />Pulp Cap-indirect nearly exposed $42 $44 <br />Biopsy OralTissue $138 $144 <br />Pin Retention/tooth $28 $29 <br />Band & Loop/Quadrant Impress $0 $0 <br />Band & Loop/Quadrant Deliver 209125 $221 $230 <br />Fixed Bilateral Impress $0 $0 <br />Fixed Bilateral Deliver 419/30 $445 $463 <br />Occlusal guard, by report minimize bruxism $274/95 lab $274 $265 <br />Fabrication of Athletic Mouthguard $100 $104 <br />Root Canal Therapy Anterior $400 $416 <br />Root Canal Therapy Bicuspid $475 $494 <br />Root Canal Therapy Molar $600 $624 <br />Flat Fee Fabrication of Allelic Moutguard Projects $15 $16 <br />Boll and Bite Mouthguards (students with braces) $5 $5 <br /> <br />Health Personal Health Fees s <br />Drainage of Skin Abscess $112 $116 <br />Drainage of Skin Abscess $191 $198 <br />Drainage of Pilonidal Cyst $186 $193 <br />Remove Foreign Body $127 $132 <br />Drainage of Hematoma/Fluid $138 $144 <br />Puncture Drainage of Lesion $90 $94 <br />Debride Infected Skin $53 $55 <br />Paring of corn/callus (1 lesion) $44 $46 <br />Remove Skin Tags $85 $88 <br />Shave Skin Lesion $69 $71 <br />Remove Skin Lesion Excision 0.5cm or Less $127 $132 <br />Remove Skin Lesion Excision 0.6 -1.OCm $149 $155 <br />Remove Skin Lesion Excision 1.1-2.OCm $164 $171 <br />Remove Skin Lesion Excision 2.1-3.OCm $186 $193 <br />Remove Skin Lesion Excision 0.5cm or Less $127 $132 <br />Remove Skin Lesion Excision 0.6 -1.OCm $154 $160 <br />Remove Skin Lesion Excision 1.1-2.OCm $175 $182 <br />Remove Skin lesion Excision 2,1-3.Ocm $207 $215 <br />Trim Nail(s) $22 $22 <br />Debride Nai11-5 $32 $33 <br />Drain Blood from Under Nail $53 $55 <br />Norplant (Remove) $212 $221 <br />Repair Superficial Wound(s) 2.5cm or less $164 $171 <br />Repair Superficial Wound(s) 2.6-7.5cm $175 $162 <br />Initial Burn(s) Treatment $80 $83 <br />Dsg and/or debridement, small $92 $96 <br />Destroy Benign/Premal Lesion $69 $71 <br />Destroy Lesions, 2-14 $17 $18 <br />Destruct Lesion(s), 1-14 $104 $108 <br />Chem. Caul of granulation tissue $75 $78 <br />Inject Single Tendon-Ligament-Cyst $69 $71 <br />Inject Single Tendon Orgin ?Insertion $64 $66 <br />Inject Single-Multi Trigger Pts, 1-2 Muscles $64 $66 <br />Inject Single-Multi Trigger Pts, 3+ Muscles $74 $77 <br />Drain/Inject, Small Joint or Bursa $64 $66 <br />Drain/Inject, Intermediate Joint or Bursa $69 $71 <br />Drain/Inject, Major Joint or Bursa $80 $83 <br />Drain Finger Abscess, Simple $313 $325 <br />Apply Finger Spl(nt, Static $42 $44 <br />Remove foreign body intranasal $232 $241 <br />Control Nosebleed $117 $122 <br />Lab: Venlpuncture $17 $18 <br />Capillary Puncture $11 $11 <br />Incise External Hemmorrhofds $175 $182 <br />Page 2 of 6 <br />