HomeMy WebLinkAboutC.054.93010_0525 (2)I
Notes:
Medicaid reimbursements are based on an updated list as of August 29, 200 .
In-house computer system will write a discount allowance for any amount not covered by Medicaid and the patient
will not be required to pay the difference.
Cdt 3 Codes
Descriptions ICHD Fee
117.00 115.00
D2386
Resin 2 Surface Perm
95.00
83.00
D2381
Resin 2 Surface Prim
148.00
143:20
D2387
Resin 3+ Surface Perm
167.00
68.50
D2336
Resin Crown - Prim.
59.00
19.00
D2940
Sedative Filling
103.00
83.00
D3220
Pulpotomy - Excl. Rest
141,00
115.00
D2930
SSC - Primary
174.00
173.00
D2931
SSC - Permanent
100.00
78.00
D2950
Crown Buildup
21.20
20.20
D2951
Pin Placement
139.00
60.57
D2970
Temporary Crown
35.00
16.00
D3110
Pulp Cap Direct
369.00
185.99
D3310
RCT- Anterior
405.00
405.00
D3330
RCT Molar
76.00
56.00
D7110
Ext. -Primary & Perm
76.00
56.00
D7120
Ext. - Each Additional Tooth
136.00
58.00
D7210
Surg. Ext. - Erupted
97.00
64.00
D7220
Soft Tis. Impact
130.00
90.82
D7230
Partial Bony Impact
250.00
121.27
D7240
Bony Impact
300.00
151.60
D7241
Bony Impact w/compl.
120.00
52.86
D7250
Resid. Roots - Unerupted
90.00
19.00
D7510
I &D Intra Oral
35.00
23.00
D9110
Emerg. Pallative Tx.
39.00
26.00
D9230
Analgesia
4$.00
13.22
D9610
Drug Inject.
26,00
16.00
D9630
Other Drug/Med,
Notes:
Medicaid reimbursements are based on an updated list as of August 29, 200 .
In-house computer system will write a discount allowance for any amount not covered by Medicaid and the patient
will not be required to pay the difference.
Cdt 3 Codes
Descriptions ICHD Fee
D3351
Recalcification - Initial Visit
D3352
Recalcification - Interim $125
500
Medication Replacement
D3353
Recalcification -Final Visit $200
50
with Root Canal Therapy $60
D2920
Recement Crown $76
Extraction - Each Additional
D7120
Tooth
50
ENVIRONMENTAL HEALTH
11
DIVISION
User Fee Schedule
Fiscal Year 2001-2002
Septic System Permit
Type I or 1I System
Type III System
Type IV -VI System
Septic System Repair Permit
Relayout of Septic System Permit:
Limited
Comprehensive
Existing System Inspection
Installer Fee For Uncancelled Appointment
Medicaid
$103.33
$82.66
$154.99
19.00
Was $56.00
Now $57.00
FY'00-`01
FY'01-`02
$175
$175
300
300
500
500
No charge
No charge
50
50
Full Permit Fee
Full Permit Fee
50
50
50
50
11