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Dental Health Fees <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 here are at 100%. 22 <br /> PRESENT <br /> 100% 100% <br /> EXTRACTION FEE (1) FEE (2) <br /> Permanent Tooth <br /> Primary Tooth 45 <br /> Each Additional Tooth -•® <br /> Surgical 40 <br /> FLORIDE 65 80 <br /> Topical <br /> MISCELLANEOUS <br /> Occulsal Equilibration <br /> NIIIIII <br /> Fractured Tooth 15 <br /> I & D Minor Surgery S0 60 <br /> Oral Hygiene Instructions 40 <br /> Palliative Treatment 20 <br /> IIIIIIIIIEEI <br /> Pin Retention, Per Tooth 20 - <br /> Study Model 10 20 <br /> Treatment Restoration 30 <br /> 'ROPHYLAXIS (cleaning) 25 40 <br /> Adult <br /> Child 30 40 <br /> 'ULP 20 20 <br /> Pulp Cap Direct <br /> Pulp Cap Indirect 40 40 <br /> Pulpotomy 40 40 <br /> ELEMENT 50 —® <br /> Recement <br /> =ALING 25 40 <br /> Gross Scaling <br /> Periodontal Scale Root Plane 35 60 <br /> Per Quadrant <br /> ALANTS 40 70 <br /> Per Quadrant <br /> Per Tooth 30 40 <br /> — <br /> ACE MAINTAINERS ® 20 <br /> Band & Loop, Per Quadrant <br /> Distal Shoe, Per Quadrant 11111111111111E1 105 <br /> Fixed Habit Appl 120 <br /> Lingual Arch 125 250 <br /> Removable Bilateral Appl 150 210 <br /> 150 IIIIIIIIIIIIMI <br /> Removable Habit Appl <br /> 250 <br /> Present Fees: Fee currently charged to 100% pay patients at Orange County Dental Clinic. <br /> Recommended 100% Fee: Recommended new fees. <br /> • <br /> 1OTE** <br /> Minimum Charge of$15 per Visit <br />