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M anager's Recommended Fee Schedule- FY 2015-16 38 <br /> Manager's Recommended Fee Last <br /> Department/Program Description Current Fee Schedule for FY 2015-16* Revision <br /> D3220 Pul otort $183.00 2013 <br /> D2930 SSC Primary Tooth $247.00 2013 <br /> D2931 SSC Permanent Tooth $298.00 2013 <br /> D2932 Prebacricated Resin Crown $323.00 2013 <br /> D2934 Prefthestcoat SSC prim.Tooth $327.00 2013 <br /> D2940 Sedative F $113.00 2013 <br /> D9110 Palliative Treatment $115.00 2013 <br /> E7140 Ext.Erated Tooth Prim/Perm $162.00 2013 <br /> D7210 Extraction Sur ical-100+ $253.00 2013 <br /> D7111 Ext.corral remnants deciduous $122.00 2013 <br /> D7310 Alveo last extractions /uad. $270.00 2013 <br /> Alveloplasty in conjunction with extraction 1-3 teeth <br /> D7311 1per quadr ant $273.00 2013 <br /> Alveloplasty not in conjunction with extraction 4 or <br /> D7320 more tooth spaces per quadrant $404.00 2013 <br /> Alveloplasty not in conjunction with extraction 1-3 <br /> D7321 tooth spaces per quadrant $384.00 2013 <br /> D2920 Recement Crown NOT cov.by MA $100.00 2013 <br /> D0470 Study Models $104.00 2013 <br /> D7510 I&D Minor Surgery $217.00 2013 <br /> D9951 Occuusal Adjustment Limited $166.00 2013 <br /> D9999 Fractured Tooth Txt. $70.00 2013 <br /> D3110 Pulp Cap-direct exp.Pulp MED $76.00 2013 <br /> E3120 Pulp Cap-indirect nearly exposed $77.00 2013 <br /> D7286 Biopsy Oral Tissue $298.00 2013 <br /> D2951 Pin Retention/tooth $67.00 2012 <br /> MED Bared&Loop/Quadrant Impress $0.00 2013 <br /> D1510 Bared&Loop/Quadrant Deliver 209/25 $287.00 2013 <br /> MED Fixed Bilateral Impress $0.00 2013 <br /> ID 1515 Fixed Bilateral Deliver 419/30 $393.00 2013 <br /> Occlusal guard,by report minimize braxism <br /> D9940 $274/95 lab $549.00 2013 <br /> D9941 Fabrication of Athletic Mouffiguard $236.00 2013 <br /> D3310 Root Canal Therapy Anterior $676.00 2013 <br /> D3320 Root Canal Therapy Bicuspid $780.00 2013 <br /> D3330 Root Canal Therapy Molar $943.00 2013 <br /> Flat Fee Fabrication of Athletic Mout uard Projects $17.00 2009 <br /> Boil and Bite Mouffiguards students with braces $5.00 2007 <br /> Sliding fee recommendation is to discontinue the <br /> $30 per preventative visit and$30 per procedure <br /> fee.Recommending to slide to 20%with a <br /> Minimum charge for dental visit minimum of$30 per visit. 2013 <br /> * Any fee changes wi I I be included in this column; <br /> a bl ank besi de each f ee means there i s no f ee change i n FY 2015-16 Manager Recommended Fee Schedule <br />