Orange County NC Website
Commissioner Approved Fee Schedule- FY 2016-17 ATTACHMENT 4 <br /> 41 <br /> Approved Fee Change for Last <br /> De artment/Pro ram Description Current Fee FY2O16-17 Revision <br /> ADA Code <br /> Dental Health D0150 Comprehensive Oral Evaluation $80.00 2013 <br /> Oral Evaluation for a patient under three years of <br /> age and counseling with primen caregiver 26 $61.00 2015 <br /> D0120 Periodic Oral Evaluation $45.00 2013 <br /> D0140 Limited Oral Evaluation $69.00 2013 <br /> D0170 Re-evaluation-limited,problem $65.00 2013 <br /> D9310 Consultation $122.00 2013 <br /> D0330 Panoramic Film $100.00 2013 <br /> D0270 BWX I Film $26.00 2013 <br /> D0272 BWX 2 Films $41.00 2013 <br /> D0273 Bitewings-threfilms $51.00 2013 <br /> D0274 BWX 4 Films $58.00 2013 <br /> D0220 Ist Intraoral PA Film $26.00 2013 <br /> D0230 Additional PA Film $23.00 2013 <br /> D0240 Intraoral Occulusal Film $38.00 2013 <br /> D0210 Full Mouth Series w BWX $120.00 2013 <br /> D!120 Pro pin/Child underage 13 $61.00 2013 <br /> D I 110 Pro pin/Adult age 13 and u $82.00 2013 <br /> D1203 Fluoride Varnish(age 13&under $33.00 2013 <br /> D1204 Fluoride Varnish(age 13-20 $33.00 2013 <br /> Topical Fluoride varnish;therapeutic application for <br /> D1206 moderate to high caries risk atients $39.00 2013 <br /> D1351 Sealant/NEWLY ERUPTED TEETH $49.00 2013 <br /> Re-upplic ation of sealant 27 $49.00 2015 <br /> D4342 Scale/Root Planing 1-3 teeth / $167.00 2013 <br /> D4341 Scale Root Planing 41 teeth / $231.00 2013 <br /> D4355 Full mouth Debridement $168.00 2013 <br /> D4910 Periodontal Maintenance $127.00 2013 <br /> D2140 1 Amal One Surface Prim/Perin $130.00 2013 <br /> D2150 Amal Tv o Surface Prim/Perin $164.00 2013 <br /> D2160 Amal Three Surface Prim/Perm $198.00 2013 <br /> D2161 Amal Four Surface Prim/Perm $236.00 2013 <br /> D2330 Resin One Surface Anterior $148.00 2013 <br /> D2331 Resin Tv o Surface Anterior $183.00 2013 <br /> D2332 Resin Three Surface Anterior $227.00 2013 <br /> D2335 Resin Four Surface Anterior $288.00 2013 <br /> D2390 Resin Comp.Crown Ant.Prim $414.00 2013 <br /> D2391 Resin Comp.Isur.Post-Prim/Perm $162.00 2013 <br /> D2392 Resin Comp.2sur.Post-Prim/Perm $212.00 2013 <br /> D2393 Resin Comp.3sur.Posterior Perin $261.00 2013 <br /> D2394 Resin Com.4+sur.Posterior Perin $314.00 2013 <br /> D9910 Applicati on of Desensitizing Medicament $57.00 2013 <br /> Application of Desensitizing Resin for cervical <br /> D9911 and/or root surface per tooth $70.00 2013 <br /> * Any fee changes wi I I be i nd uded i n thi s col umn; <br /> a bl ank besi de each fee means there i s no fee change i n FY 2016-17 Manager Recommended Fee Schedule <br />