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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 />D7321 <br />Alveloplasty not in conjunction with extraction 1-3 <br />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 Occulsal 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 />D3120 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 Band & Loop/Quadrant Impress $0.00 2013 <br />D1510 Band & Loop/Quadrant Deliver 209/25 $287.00 2013 <br />MED Fixed Bilateral Impress $0.00 2013 <br />D1520 Space Maintainer-Removable, Unilateral $0.00 $287.00 NEW <br />D1525 Space Maintainer-Removable, Bilateral $0.00 $287.00 NEW <br />D1550 Recementation of Space Maintainer $0.00 $57.00 NEW <br />D1555 Removal of Fixed Space Maintainer $0.00 $25.00 NEW <br />D1515 Fixed Bilateral Deliver 419/30 $393.00 2013 <br />D9940 <br />Occlusal guard, by report minimize bruxism <br />$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 Mouthguards (students with braces)$5.00 2007 <br />Minimum charge for dental visit <br />Sliding fee recommendation is to discontinue <br />the $30 per preventative visit and $30 per <br />procedure fee. Recommending to slide to 20% <br />with a 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 Drainage of Pilonidal Cyst $195.00 2009 <br />53