Agenda - 10-17-2000-8e - Laserfiche WebLink

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ADA 0 DENTAL SERVICES 10054 Medicaid Proposed Number of Revenue ADA A DENTAL SERVICES 10DY. Medicaid Proposed Lab Number of~Rev~ Pea Fee New Fee Services Pro)ection Pea New Fee Fee Services Proj D0150 Comprehensive Oral Exam '~ 40 38 1811 6,878102920 Recementing 501 1g 1 D0120 Periodic Oral Exam 30 i ~ 28 257 ~, 7,196100470 Study Models 451 31.00 ' D0140 Limited Oral Exam 35 i 38 3B~ 62', 2,3561 D7510 I b D Minor SurgeN I 501 D9310 ,Consultation 30 1 _ '~D9951 Occulsal Equilibrati n 751 p0330 ~~, Panoramic Film 60 _ o ' 41 - ~ _ 14 ~ 574; D0999 Fractured Tooth Txt 80+ ~ ~ ' b0270 'BWX 1 Film 15 10 4~ 401p3110 PulpCap~irect 401 18 1 I, p0272 8WX2Films 26 17 2001 3,400 1 03 7 20 PulpCapandiritct 40 p0274 8WX 4 Films 35 33 ~, ~ 331 1089 i b7288 ~~ Biopsy Oral Tissue 751 54.58 D0275 ~ BWX Each Additional Film 12 ~, 1 1 OTHER 'I ~ ~ '1 '1 170220 ! 1st Intrdo2l PA Film 15 14 ~ ~ ~ ;~ 781 10841 ~ ~ ' po230 Additional PA Film 12 10 A 52! 4301 D1610 Band & LaopJOuadrant 176 115 20 41 p0240 :Inlrao210cculusalFilm I 15 16 1~ 81' 1296101510 lpisialShoelOuadrant j 2001 115 ' D0210 ~ Full Mouth Series w BWX I 70 54 - I I D1515 ',Lingual Arch 1 276 173 ~ 30 2'. 07120 ,Prophy/Child 25 28.00 15 j 3901 D1520 ', Removeable Unilateral 250 ~ ' 07203 ~ Fluoride Treatment 16 19 S 17 j 3231 D1525 Remdveable Bilateral 250 ~. I i 01201 ,Prophy/Fluoride Child c13) 40 41 285 1D,865 ~ D8210 Removable Habit Appl. 275 I D1110 . Prophy/Adult 46 32 - ` ~ ~ 32 1,0241 D8220 ~ Fixed Hatt Appl. 275 ifr4,, I D1205 Prophy/Fluodde Ad01t (13-21) 80 43 ~ '~y 29 1 1~47 I, Deliver Appliance NC . '' ~ ' 04345 Pedo Spline Gross 80 ~ ^- ~ : Chapc Appliance NC ~~. 04341 Perto Scale Root Plane Per Quad 80 43 _- 1 ~ RenWVe Appliance NC 7 t_.:-~ D4355 Full Mduth Debddement 80 _ BO ~~»~ 6 ~ 380 ~Haaltnchdp wpayment 5 ~ F 02110 Amalgam one Surface Prim 50 58.00 ~ 23 1,334 ~ I< . . D2120 Aural Two SurFap Prim 60 81.00 ~ 78 6,31a . . D2130 D2131 Aural Three Surfap Prim Aural Four Surface Prim 70 86 102 "- 3 115 ~ 306 ' D2140 Aural One Surface Penn 80 68.00 76 4,400 D2160 Aural Two Surface Perm 70 61.00 54 4,374 D2180 Aural Three SurlBCe Perm B5 102 - 18 1,632 D2161 Aural Fqur Burlap Pam1 90 115 4 460 D2161 Aural Flve Surface Perm 100 p2330 Resin One Surface Anterior 85 68-00 36 2,080 D2331 Resin two Surface Anterior 75 83. 9 747 D2332 Resin Three Surface Anterior 85 102 5 510 I I D2335 Resin Four Surface Antedar 100 116 5 575 D2380 Resin One Sufidce Posl/Prlm 75 Se 51 2,950 D2381 Resin Two Surface Pasf/Prlm 10D 83 7 587 D2382 Resin Three Surface Posf/Prlm 126 2 D I D2385 Resin One Surface Post/Perm 80 66.00 59 3,422 D2386 Resin Two Surface Pdsf/Perm 105 115 14 1,610 02387 Resin Three Surface PosflPerm 130 143.20 02388 Ra3in FOUr Surfep3 Postlf enn 175.20 D1351 Sealant 30 . 32 477 13,264 D3220 Pulpotom 86 83 21 1,743 D2930 SSC Primary Tooth 125 715+ 43 4,945 D2931 SSC Permanent Tooth 186 173 p2932 Prebacriceted Resin Crown 150 - I D2833 Prefabricated SSC w Resin Wln 150 103.33 i D2940 Treatmem Restoration 5D 19 2 30 j D2961 Pin RetentionrtDOth 25 20.20 D9110 Palllatlve Treatment 45 23 12 270 1 D7110 Extraction Pdmary To001 55 57 ~ 71 4,047 ~ D7120 Extraction Prim. TOpOm adtlidOnal 50 56 6 330 D7110 Extracton Pannenant Tooth 65 57 29 1,653 D7120 Extracton Penn. Additlonal Tooth 80 56 5 280 p7210 Extraction Surgical 100+ ~ 68 5 290 Post Op NC '~ D2336 Com resin prawn ant. Prim. 68.5 Topl Rww1w Prof ~Ct101/. - :: i . Based art teat aagl year 9P60r. ' Madlpid PfOdtlGtlOfr. - 1 ~Y.6d6" ~ TotalalaWWldRavarrwCoYar:IgE' In flsal ypr 99-00 was I based oln f100 par vhk. 5702,20Q Medicaid R9vMtUa Prpjalykip ~I for flaral ywr 00-0'19r9s ~ 1 s1Dl,I700 Lost D.tnar M.raeaw Rrmrarar afy.caan wear tits far sarrks o3z Medicaid fe9 for Service 1 OH/00