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HomeMy WebLinkAboutC.054.93010_0524Medicaid/Non-Medicaid Reimbursed Classes W8203 Childbirth Education Series W8205 Parenting Education Series Childbirth Refresher Series Dental Medicaid Per Visit --Flat Fee $100.00 Medical Nutrition Therapy Medicaid/Non-Medicald Sliding Fee MNT for Women MNT for Children * Note that there two CPT codes for MNT as of July 2001. 97802 Initial Assessment (face to face) 97803 Re -Assessment (face to face) ( ) Will utilize Sliding Fee Scale for non -Medicaid * County employees receive a$ 10 discount $87.00 $87.00( ) 75.00 75.00() 33.00 33.00() $47.00/visit - $18.00/15 min. ( ) $50.00/visit - $18.00/15 min. ( ) $18.00/15 min ( ) $18.00/15 min ( ) All state adjustments made to Medicaid charges will automatically be implemented in the county fee schedule. DENTAL FEES FOR SERVICES - ALLIED HEALTH DIVISION Health Medicaid D0150 Initial Oral Exam 50.00 38.00 D0120 Recall Exam 29.00 28.00 D0140 Emergency Exam &/or time spent on uncooperative 39.00 38.00 D0210 Complete Series X-rays 75.00 54.00 D0220 Periapical X-ray 14.00 14.00 D0230 Periapical - Two or More 12.00 10.00 D0240 Occlusal P.A. 24.00 16.00 D0270 Bitewings - Single Film 12.00 10.00 D0272 Bitewings x 2 23.00 17.00 D0274 Bitewings x 4 42.00 33.00 D0330 Panorex X-rays 60.00 41.00 131 110 Prophy (Adult) age 13 and older 50.00 32.00 Dl 120 Prophy (Child) age 13 and under 38.00 26.00 D1201 Prophy w/Fluoride (Child) age 13 and under 51.00 41.00 D1203 Prophy w/Fluoride Varnish (Child) age 13 and under 20.00 19.00 D1205 Prophy w/Fiuoride (Adult) age 13 and older 62.00 43.00 D1351 Sealants 32.00 32.00 D4341 Root Planning/Scale (ea. quad.) 141.00 43.00 D4355 Gross Scale - Perio 103.00 60.00 D4910 Periodontal Maint. Tx. 77.00 38.00 D1510 Space Maint. Fixed - Unilateral 175.00 115.00 D1515 Space Maint. Fixed - Bilateral 180.00 173.00 D2110 Amalgam 1 Surf Primany 60.00 58.00 D2120 Amalgam 2 Surf Primary 81 .00 81_00 D2130 Amalgam 3 Surf Primary 102.00 102.00 D2131 Amalgam 4 Surf Primary 115.00 115.00 132140 Amalgam I Surf Perm. 66.00 58.00 D2150 Amalgam 2 Surf Perm. 83.00 81.00 D2160 Amalgam 3 Surf Pem. 102.00 102.00 D2161 Amalgam 4 Surf Perm. 124.00 115.00 D2330 Resin I Surf Ant. 78.00 58.00 D2331 Resin 2 Surf Ant. 95.00 83.00 D2332 Resin 3 Surf Ant 120.00 102.00 D2335 Resin 4 Surf Ant. 141.00 115.00 D2380 Resin I Surf. Poster Primary 75.00 58.00 D2385 Resin I Surf Poster Perm. 84.00 58.00 10