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Commissioner Approved Fee Schedule - FY 2019-20 <br />* Any fee changes will be included in this column; <br />a blank beside each fee means there is no fee change in FY 2019-20 Commissioner Approved Fee Schedule <br />Department/Program Description Current Fee <br />Commissioner Approved <br />Fee Change for <br />FY 2019-20* <br />Last <br />Revision <br />D7210 Extraction Surgical - 100+$253.00 2013 <br />D7250 Extract Root Tip $253.00 2018 <br />D7286 Biopsy Oral Tissue $298.00 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 />D7321 <br />Alveloplasty not in conjunction with extraction 1-3 <br />tooth spaces per quadrant $384.00 2013 <br />D7510 I & D Minor Surgery $217.00 2013 <br />D9110 Palliative Treatment $115.00 2013 <br />D9310 Consultation $122.00 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 />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 />D9951 Occulsal Adjustment Limited $166.00 2013 <br />D9999 Fractured Tooth Txt.$70.00 2013 <br />MED Band & Loop/Quadrant Impress $0.00 2013 <br />MED Fixed Bilateral Impress $0.00 2013 <br />D0145 <br />Oral evaluation for a patient under 3 years of age <br />and counseling with primary caregiver $61.00 2015 <br />D1352 Reapplication of sealant $49.00 2015 <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 />54