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Commissioner Approved Fee Schedule- FY 2017-18 ATTACHMENT 4 37 <br /> Commissioner Approved <br /> Fee Change for Last <br /> De artment/Pro ram Description Current Fee FY 2017-18* Revision <br /> Alveloplasty not in conjunction with extraction 1-3 <br /> D7321 tooth spaces per quadrant $384.00 2013 <br /> D2920 Recement Crown NOT co,by MA $100.00 2013 <br /> D0470 Study Models $104.00 2013 <br /> D7510 I&D Minor S $217.00 2013 <br /> D9951 10cculsal Ad'usbnent Limited $166.00 2013 <br /> D9999 Fractured Tooth Txt. $70.00 2013 <br /> D3110 Pul V C ex p.Pul p MED $76.00 2013 <br /> D3120 Pulp C indhwctneardyexposed $77.00 2013 <br /> D7286 Bi s Oral Tissue $298.00 2013 <br /> D2951 Pin Retendodtoo. $67.00 2012 <br /> MED Band&Ixop/Quadmat Impress $0.00 2013 <br /> 131510 Band&Loo/ [Deliver 20925 $287.00 2013 <br /> MED Fixed Bilateral hn ress $0.00 2013 <br /> D1515 Fixed Bilateral Deliver 419/30 $393.00 2013 <br /> Occlusal guard,by report minimize bnurism <br /> 139940 $274/95 lab $549.00 2013 <br /> D9941 Fabrication of Athletic Mouthguard $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 Moutguard Projects $17.00 2009 <br /> Boil and Bite Moudguards(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 /> CPT Code <br /> Personal Health 10060 Drainage of Skin Abscess $117.00 2009 <br /> 10061 Drainage of Skin Abscess $200.00 2009 <br /> 10080 Drai eofPilonidalC [ $195.00 2009 <br /> 10120 Remove Forei Bod $133.00 2009 <br /> 10140 Drainage ofHematoma/Fluid $147.00 2009 <br /> 10160 Puncture Drainage of Lesion $94.00 2008 <br /> 11000 Debride Infected Skin $56.00 2009 <br /> 110 Paring ofcom/callus(I lesion) $46.00 2009 <br /> 11200 55 Remove Skin Tags $89.00 2007 <br /> 11719 Trim Nails $22.00 2008 <br /> 11720 13ebride Nail 1-5 $33.00 2008 <br /> 11730 Avulsion of Nail Plate $97.00 2011 <br /> 11740 Drain Blood from Under Nail $56.00 2009 <br /> 11976 N last ove $223.00 2008 <br /> 11981 Insatio non-biodegradable drug $250.00 2012 <br /> 11982 Removal non-biodegradable drug $154.00 2009 <br /> 11983 Removal with e.sert on.non-biodegradable drug $234.00 2009 <br /> Repair airs rcial Wound(s)2.5cm or less $171.00 2008 <br /> 12002 R TreW s 2.6-7.5m $184.00 2009 <br /> 16000 <br /> $84.00 2009 <br /> 16020 Ds and/or debridement small $97.00 2009 <br /> 17000 Destroy Beni rernal Lesion $72.00 2009 <br /> 17003 Destroy Lesions 2-14 $18.00 2009 <br /> 17110 Destruct Lesions 1-14 $109.00 2009 <br /> 17250 Chem.Caut ot'granulation tissue $79.00 2009 <br /> 20550 Inject Sin a Talon-Li aa-C t $72.00 2009 <br /> 20551 Inject Single on Drain?Insertion $67.00 2009 <br /> 20552 Inject Sim de-Multi Trigger Pts 1-2 Muscles $67.00 2008 <br /> 20553 Inject Single-Multi Trigger Pts 3+Muscles $78.00 2009 <br /> 20600 Drain/Inject,Small Joint or Bursa $67.00 2008 <br /> 20605 Drain/Inject,Intermediate Joint or Bursa $72.00 2007 <br /> 20610 Drain/Inject,Major Joint or Bursa $84.00 2009 <br /> 26010 Drain Finger Abscsss Simple $329.00 2009 <br /> 29130 Apply Finger Splint,Static $44.00 2009 <br /> 30300 Remove foreign body iraranasal $244.00 2009 <br /> 30901 Control Nosebleed $123.00 2009 <br /> 36415 Lab:Veni uncture $18.00 2009 <br /> 36416 Capillary Puncture $15.00 2012 <br /> 46083 Incise External Henmorrhoids $184.00 2009 <br /> 46600 Di stic Arosco $100.00 2009 <br /> * Any fee changes wi I I be included in this column; <br /> a bi ank besi de each fee means there i s no fee change i n FY 2017-18 Commissioner Approved Fee Schedule <br />