NATIONFEESCHEDULEHASSELLCORRECTION - Copy
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D4211<br />
GINGIVECTOMY OR GINGIVOPLASTY – ONE TO THREE CONTIGUOUS TEETH OR TOOTH BOUNDED<br />
SPACES PER QUADRANT $238.00 $107.00 $91.00<br />
D4249 CLINICAL CROWN LENGHTHENING – HARD TISSUE $570.00 $320.00<br />
$170.00<br />
D4341 PERIODONTAL SCALING AND ROOT PLANING – FOUR OR MORE TEETH PER $190.00 $133.00<br />
$99.00<br />
D4355 FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AN $133.00 $77.00<br />
$64.00<br />
D5110 COMPLETE DENTURE – MAXILLARY $1,190.00 $776.00 $590.00<br />
D5120 COMPLETE DENTURE – MANDIBULAR $1,190.00 $776.00<br />
$590.00<br />
D5130 IMMEDIATE DENTURE – MAXILLARY $1,280.00 $828.00 $650.00<br />
D5140 IMMEDIATE DENTURE – MANDIBULAR $1,280.00 $828.00<br />
$650.00<br />
D5211<br />
MAXILLARY PARTIAL DENTURE – RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS,<br />
RESTS AND TEETH) $1,103.00 $600.00<br />
$549.00<br />
D5212<br />
MANDIBULAR PARTIAL DENTURE – RESIN BASE (INCLUDING ANY CONCENTIONAL CLASPS,<br />
RESTS AND TEETH) $1,103.00 $600.00<br />
$549.00<br />
D5213<br />
MAXILLARY PARTIAL DENTURE – CAST METAL FRAMEWORK WITH RESIN DENTURE BASES<br />
(INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH) $1,255.00 $650.00<br />
$590.00<br />
D5214<br />
MANDIBULAR PARTIAL DENTURE – CAST METAL FRAMEWORK WITH RESIN DENTURE BASES<br />
(INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH) $1,255.00 $650.00<br />
$590.00<br />
D5410/11 ADJUST COMPLETE DENTURE - MAXILLARY/MAND $88.00 $50.00<br />
$40.00<br />
D5421/22 ADJUST PARTIAL DENTURE – MAXILLARY/MAND $90.00 $52.00<br />
$40.00<br />
D5510 REPAIR BROKEN COMPLETE DENTURE BASE $167.00 $107.00<br />
$78.00<br />
D5520 REPLACE MISSING OR BROKEN TEETH - COMPLETE DENTURE (EACH TOOTH) $142.00 $88.00<br />
$60.00<br />
D5710 REBASE COMPLETE MAXILLARY DENTURE $233.00 $213.00<br />
$110.00<br />
D5711 REBASE COMPLETE MANDIBULAR DENTURE $233.00 $213.00<br />
$110.00<br />
D5810 INTERIM COMPLETE DENTURE (MAXILLARY) $673.00 $388.00<br />
$285.00