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55 <br /> Commissioner Approved <br /> Fee Changes for Last <br /> Department/Program Description Current Fee FY 2021-22* Revision <br /> D4341 Scale Root Planing 4>teeth p/q $231.00 2013 <br /> D4342 Scale/Root Planing 1-3 teeth p/q $167.00 2013 <br /> Scaling in presence of generalized moderate or <br /> D4346 severe gingival inflammation $95.00 2018 <br /> D4355 Full mouth Debridement $168.00 2013 <br /> D4910 Periodontal Maintenance $127.00 2013 <br /> D5411 Adjust Complete Denture-lower $45.00 2018 <br /> D6930 Recement Bridge $100.00 2018 <br /> D7111 Ext.comal remnants deciduous $122.00 2013 <br /> D7140 Ext.Erupted Tooth Prim/Perm $162.00 2013 <br /> D7210 Extraction Surgical- 100+ $253.00 2013 <br /> D7250 Extract Root Tip $253.00 2018 <br /> D7286 Biopsy Oral Tissue $298.00 2013 <br /> D7310 Alveoplasty extractions p/quad. $270.00 2013 <br /> Alveloplasty in conjunction with extraction 1-3 <br /> D7311 teeth per quadrant $273.00 2013 <br /> Alveloplasty not in conjunction with extraction 4 or <br /> D7320 more tooth spaces per quadrant $404.00 2013 <br /> Alveloplasty not in conjunction with extraction 1-3 <br /> D7321 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 lConsultation $122.00 2013 <br /> D9910 Application of Desensitizing Medicament $57.00 2013 <br /> Application of Desensitizing Resin for cervical <br /> D9911 and/or root surface per tooth $70.00 2013 <br /> Occlusal guard,by report minimize bruxism <br /> D9940 $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 /> Oral evaluation for a patient under 3 years of age <br /> D0145 and counseling with primary caregiver $61.00 2015 <br /> D1352 lReapplication of sealant $49.00 2015 <br />