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Commissioner Approved Fee Schedule - FY 2018-19 <br />* Any fee changes will be included in this column; <br />a blank beside each fee means there is no fee change in FY 2018-19 Commissioner Approved Fee Schedule <br />Department/Program Description Current Fee <br />Commissioner Approved <br />Fee Change for <br />FY 2018-19* <br />Last <br />Revision <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 Two 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. 1sur.Post-Prim/Perm $162.00 2013 <br />D2392 Resin Comp. 2sur.Post-Prim/Perm $212.00 2013 <br />D2393 Resin Comp. 3sur.Posterior Perm $261.00 2013 <br />D2394 Resin Comp.4+sur.Posterior Perm $314.00 2013 <br />D9910 Application of Desensitizing Medicament $57.00 2013 <br />D9911 <br />Application of Desensitizing Resin for cervical <br />and/or root surface per tooth $70.00 2013 <br />D3220 Pulpotomy $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 Prefab.est.coat SSC prim. Tooth $327.00 2013 <br />D2940 Sedative Filling $113.00 2013 <br />D9110 Palliative Treatment $115.00 2013 <br />D7140 Ext. Erupted Tooth Prim/Perm $162.00 2013 <br />D7210 Extraction Surgical - 100+$253.00 2013 <br />D7250 Extract Root Tip $0.00 $253.00 NEW <br />D7111 Ext. cornal remnants deciduous $122.00 2013 <br />D7310 Alveoplasty extractions p/quad.$270.00 2013 <br />D7311 <br />Alveloplasty in conjunction with extraction 1-3 <br />teeth per quadrant $273.00 2013 <br />D7320 <br />Alveloplasty not in conjunction with extraction 4 or <br />more tooth spaces per quadrant $404.00 2013 <br />52