<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <!--#include file="feeTop.asp"--> <HTML> <HEAD> <META http-equiv=Content-Type content="text/html; charset=unicode"> <MAP NAME="MenuMap"> <AREA SHAPE="RECT" COORDS="0,0,57,20" href="index.htm" TARGET="_self"> <AREA SHAPE="RECT" COORDS="59,0,170,20" href="schedule.htm" TARGET="_self"> <AREA SHAPE="RECT" COORDS="172,0,337,20" href="index.htm#dd" TARGET="_self"> <AREA SHAPE="RECT" COORDS="339,0,446,20" href="freekit.htm" TARGET="_self"> <AREA SHAPE="RECT" COORDS="448,0,558,20" href="BrokerForm.htm" TARGET="_self"> <AREA SHAPE="RECT" COORDS="559,0,635,20" href="index.htm#PAY" TARGET ="_self"> </MAP> <META content="MSHTML 6.00.2900.2180" name=GENERATOR> <style> body {font-family:Arial, Helvetica, sans-serif; font-size:12px; font-weight:bold;} .head {color:#0000FF } table tr td {font-size:13px; font-weight:bold;} .red {color: #FF0000} </style> </HEAD><BODY> <table> <tr> <td><CENTER> <font size="3">Northeast General Dentists<BR> Fee Schedule I</b><BR> <FONT COLOR="red"><span class="red">As of March 1, 2007</b></span><BR> <FONT COLOR="#000000">(all procedures as performed by a general Dentist)</b></FONT> </CENTER> <BR> <CENTER> <A href="#CP"><IMG alt="Cosmetic Procedures" src="Graphics/cosmetic_new.gif" align=top border=0 ></A> <A href="#P"><IMG alt=Periodontics src="Graphics/periodontics_new.gif" align=top border=0></A><BR> <A href="#DPP"><IMG alt="Diagnostic &amp; Preventative Procedures" src="Graphics/diagnostic_new.gif" align=top border=0 ></A> <A href="#PF"><IMG alt="Fixed Prosthodontics" src="Graphics/fixedprosthodontics_new.gif" align=top border=0 ></A><BR> <A href="#E"><IMG alt=Endodontics src="Graphics/endodontics_new.gif" align=top border=0></A> <A href="#PR"><IMG alt=Prosthodontics src="Graphics/prosthodontics_new.gif" align=top border=0></A><BR> <A href="#O"><IMG alt="Oral Surgery" src="Graphics/oralsurgery_new.gif" align=top border=0 ></A> <A href="#RP"><IMG alt="Restorative Procedures" src="Graphics/restorativeprocedures_new.gif" align=top border=0 ></A><BR> </CENTER> <P></P></td> </tr> <tr> <td><table id="table1" borderColor="#000000" cellSpacing="2" cellPadding="2" width="95%" border="0"> <tr class="head"> <td align="left" width="6%"> <u>ADA Code</u> </b></td> <td align="left" width="59%"> <u>DIAGNOSTIC &amp; PREVENTATIVE PROCEDURES</u></b> </td> <td align="right" width="20%"> <u>MEMBER FEE</u></b></td> <td align="right" width="20%"> <u>USUAL FEE</u></b></td> </tr> <tr> <td align="left"> &nbsp;D0150</b></td> <td align="left"> Comprehensive oral evaluation - new or established</b></td> <td align="right"> No Charge*</b></td> <td align="right"> $60.00</b></td> </tr> <tr> <td align="left"> &nbsp;D0120</b></td> <td align="left">Periodic oral evaluation </b></td> <td align="right"> No Charge*</b></td> <td align="right"> $60.00</b></td> </tr> <tr> <td align="left"> &nbsp;D0140</b></td> <td align="left"> Consultation (limited oral evaluation - problem focused) </b> </td> <td align="right"> $45.00</b></td> <td align="right"> $75.00</b></td> </tr> <tr> <td align="left"> &nbsp;D0220</b></td> <td align="left"> Single x-ray (any type)</b></td> <td align="right"> $14.00</b></td> <td align="right"> $25.00</b></td> </tr> <tr> <td align="left"> &nbsp;D0210</b></td> <td align="left"> X-rays (up to full mouth, or at least 3 films taken)</b></td> <td align="right"> $50.00</b></td> <td align="right"> $115.00</b></td> </tr> <tr> <td align="left"> &nbsp;D0330</b></td> <td align="left"> X-rays Panoramic film</b></td> <td align="right"> $45.00</b></td> <td align="right"> $110.00</b></td> </tr> <tr> <td align="left"> &nbsp;D1110</b></td> <td align="left"> Adult cleaning, polishing and scaling</b></td> <td align="right"> $60.00</b></td> <td align="right"> $120.00</b></td> </tr> <tr> <td align="left"> &nbsp;D1120</b></td> <td align="left"> Child cleaning &amp; polishing - excluding fluoride</b></td> <td align="right"> $40.00</b></td> <td align="right"> $85.00</b></td> </tr> <tr> <td align="left"> &nbsp;D1203</b></td> <td align="left"> Topical fluoride treatment for children</b></td> <td align="right"> $22.00</b></td> <td align="right"> $42.00</b></td> </tr> <tr> <td align="left"> &nbsp;D9110</b></td> <td align="left"> Palliative (emergency) treatment of dental pain</b></td> <td align="right"> $40.00</b></td> <td align="right"> $99.00</b></td> </tr> <tr> <td align="left"> &nbsp;D1351</b></td> <td align="left"> Sealants - per tooth</b></td> <td align="right"> $30.00</b></td> <td align="right"> $50.00</b></td> </tr> </table> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> <P></P></td> </tr> <tr> <td><table borderColor="#000000" cellSpacing="2" cellPadding="2" width="95%" border="0" id="table3"> <tr class="head"> <td align="left" width="6%"><u>ADA Code</u> </b></td> <td align="left" width="59%"><u>RESTORATIVE PROCEDURES (FILLINGS)</u></b> </td> <td align="right" width="20%"><u>MEMBER FEE</u></b></td> <td align="right" width="20%"><u>USUAL FEE</u></b></td> </tr> <tr> <td align="left"> &nbsp;D2951</b></td> <td align="left">Pin rentention - per tooth </b></td> <td align="right">$35.00</b></td> <td align="right">$65.00</b></td> </tr> <tr> <td align="left"> &nbsp;D2940</b></td> <td align="left">Sedative filling</b></td> <td align="right">$50.00</b></td> <td align="right">$89.00</b></td> </tr> <tr class="head"> <td align="left"> &nbsp;</b></td> <td align="left" colSpan="3" height="30"><u>Silver Amalgams: <i>Permanent</i></b></u> </td> </tr> <tr> <td align="left"> &nbsp;D2140</b></td> <td align="left">One Surface</b></td> <td align="right">$64.00</b></td> <td align="right">$112.00</b></td> </tr> <tr> <td align="left"> &nbsp;D2150</b></td> <td align="left">Two Surfaces</b></td> <td align="right">$80.00</b></td> <td align="right">$147.00</b></td> </tr> <tr> <td align="left"> &nbsp;D2160</b></td> <td align="left">Three Surfaces</b></td> <td align="right">$90.00</b></td> <td align="right">$168.00</b></td> </tr> <tr> <td align="left"> &nbsp;D2161</b></td> <td align="left">Four Surfaces or more</b> </td> <td align="right">$120.00</b></td> <td align="right">$202.00</b></td> </tr> <tr class="head"> <td align="left"> &nbsp;</b></td> <td align="left" colSpan="3" height="30"><u>Composite Resins: <i>Permanent</i></u></b></td> </tr> <tr class="head"> <td align="left"> &nbsp;</b></td> <td align="left" colSpan="3" height="30"><u>Anterior Composites </u></b></td> </tr> <tr> <td align="left"> &nbsp;D2330</b></td> <td align="left">One Surface</b></td> <td align="right">$75.00</b></td> <td align="right">$118.00</b></td> </tr> <tr> <td align="left"> &nbsp;D2331</b></td> <td align="left">Two Surfaces</b></td> <td align="right">$90.00</b></td> <td align="right">$160.00</b></td> </tr> <tr> <td align="left"> &nbsp;D2332</b></td> <td align="left">Three Surfaces</b></td> <td align="right">$112.00</b></td> <td align="right">$200.00</b></td> </tr> <tr> <td align="left"> &nbsp;D2335</b></td> <td align="left">Four or more surfaces </b></td> <td align="right">$140.00</b></td> <td align="right">$235.00</b></td> </tr> <tr class="head"> <td align="left"> &nbsp;</b></td> <td align="left" colSpan="3" height="30"><u>Posterior Composites </u></b></td> </tr> <tr> <td align="left"> &nbsp;D2391</b></td> <td align="left">One Surface</b></td> <td align="right">$87.00</b></td> <td align="right">$150.00</b></td> </tr> <tr> <td align="left"> &nbsp;D2392</b></td> <td align="left">Two Surfaces</b></td> <td align="right">$111.00</b></td> <td align="right">$195.00</b></td> </tr> <tr> <td align="left"> &nbsp;D2393</b></td> <td align="left">Three Surfaces or more</b></td> <td align="right">$152.00</b></td> <td align="right">$260.00</b></td> </tr> <tr> <td align="left"> &nbsp;D2394</b></td> <td align="left">Four or more surfaces</b></td> <td align="right">$170.00</b></td> <td align="right">$315.00</b></td> </tr> </table> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> <P></P></td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <U>ADA Code</U> </TD> <TD WIDTH="59%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <A NAME="CP"></A><U>COSMETIC PROCEDURES</U></TD> <TD WIDTH="20%" ALIGN=right><u>MEMBER FEE</u></b></TD> <TD WIDTH="20%" ALIGN=right><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"><U> USUAL FEE</U></TD> </TR> <TR class="head"> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=3><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <U>Bonding/Veneers (per tooth)</U> </TD> </TR> <TR> <TD ALIGN=left><FONT face=Arial size=2><STRONG>D2960</STRONG></FONT></TD> <TD ALIGN=left>Labial veneer (resin) - chairside </TD> <TD ALIGN=right> $280.00</TD> <TD ALIGN=right> $425.00</TD> </TR> <TR> <TD ALIGN=left>D2962</b></TD> <TD ALIGN=left> Labial veneer (porcelain) - laboratory</TD> <TD ALIGN=right> $540.00</TD> <TD ALIGN=right> $910.00</TD> </TR> </TABLE> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> <P></P></td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <U>ADA Code</U> </TD> <TD WIDTH="59%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <A NAME="E"></A><U>ENDODONTICS PROCEDURES</U> </TD> <TD WIDTH="20%" ALIGN=right><u>MEMBER FEE</u></b></TD> <TD WIDTH="20%" ALIGN=right><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"><U> USUAL FEE</U></TD> </TR> <TR> <TD ALIGN=left>D3110</b></TD> <TD ALIGN=left>Pulp capping (excl. final restoration)</TD> <TD ALIGN=right>$45.00</TD> <TD ALIGN=right>$72.00</TD> </TR> <TR> <TD ALIGN=left>D3220</b></TD> <TD ALIGN=left> Pulpotomy (excl. final restoration)</TD> <TD ALIGN=right>$90.00</TD> <TD ALIGN=right> $156.00</TD> </TR> <TR class="head"> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=3><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <U>Root Canal Therapy (excl. final restoration)</U></TD> </TR> <TR> <TD ALIGN=left>D3310</b></TD> <TD ALIGN=left> Anterior</TD> <TD ALIGN=right> $400.00</TD> <TD ALIGN=right> $575.00</TD> </TR> <TR> <TD ALIGN=left>D3320</b></TD> <TD ALIGN=left> Bicuspid</TD> <TD ALIGN=right> $465.00</TD> <TD ALIGN=right> $740.00</TD> </TR> <TR> <TD ALIGN=left>D3330</b></TD> <TD ALIGN=left>Molar</TD> <TD ALIGN=right> $600.00</TD> <TD ALIGN=right> $830.00</TD> </TR> </TABLE> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> <P></P></td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <U>ADA Code</U> </TD> <TD WIDTH="59%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <A NAME="P"></A><U>PERIODONTICS PROCEDURES</U> </TD> <TD WIDTH="20%" ALIGN=right><u>MEMBER FEE</u></b></TD> <TD WIDTH="20%" ALIGN=right><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"><U> USUAL FEE</U></TD> </TR> <TR> <TD ALIGN=left>D4341</b></TD> <TD ALIGN=left> Periodontal scaling and root planing (per quadrant)</TD> <TD ALIGN=right>$95.00</TD> <TD ALIGN=right> $205.00</TD> </TR> <TR> <TD ALIGN=left>D4260</b></TD> <TD ALIGN=left>Osseous or mucogingival surgery (per quadrant)</TD> <TD ALIGN=right> $530.00</TD> <TD ALIGN=right> $878.00</TD> </TR> <TR> <TD ALIGN=left>D4910</b></TD> <TD ALIGN=left>Perio maintenance</TD> <TD ALIGN=right>$70.00</TD> <TD ALIGN=right> $112.00</TD> </TR> </TABLE> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <P></P></td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <U>ADA Code</U> </TD> <TD WIDTH="59%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <A NAME="O"></A><U>ORAL SURGERY PROCEDURES</U>&nbsp;</TD> <TD WIDTH="20%" ALIGN=right><u>MEMBER FEE</u></b></TD> <TD WIDTH="20%" ALIGN=right><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"><U> USUAL FEE</U></TD> </TR> <TR> <TD ALIGN=left>D7111</TD> <TD ALIGN=left>Extraction, coronal remnants - deciduos tooth </TD> <TD ALIGN=right>$70.00</TD> <TD ALIGN=right>$125.00</TD> </TR> <TR> <TD ALIGN=left>D7140</TD> <TD ALIGN=left>Extraction, erupted tooth or exposed root</TD> <TD ALIGN=right>$80.00</TD> <TD ALIGN=right>$125.00</TD> </TR> <!-- <TR> --> <!-- <TD HEIGHT=30 ALIGN=left COLSPAN=3>--> <!-- <font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff">--> <!-- <U>Extraction: Simple</U></TD>--> <!-- </TR>--> <TR> <TD ALIGN=left>D7210</b></TD> <TD ALIGN=left> Surgical extraction</TD> <TD ALIGN=right> $120.00</TD> <TD ALIGN=right> $218.00</TD> </TR> <TR> <TD ALIGN=left>D7220</b></TD> <TD ALIGN=left>Extraction - soft tissue impaction</TD> <TD ALIGN=right> $170.00</TD> <TD ALIGN=right> $270.00</TD> </TR> <TR> <TD ALIGN=left>D7230</b></TD> <TD HEIGHT=30 ALIGN=left> Extraction - partial bony impaction</TD> <TD HEIGHT=30 ALIGN=right> $215.00</b></TD> <TD HEIGHT=30 ALIGN=right> $360.00</b></TD> </TR> <TR> <TD ALIGN=left>D7240</b></TD> <TD ALIGN=left>Extraction - Full bony impaction</TD> <TD ALIGN=right> $260.00</TD> <TD ALIGN=right> $475.00</TD> </TR> <TR> <TD ALIGN=left>D7510</b></TD> <TD ALIGN=left> Incision and drainage of abscess</TD> <TD ALIGN=right>$80.00</TD> <TD ALIGN=right> $182.00</TD> </TR> <!-- <TR> --> <!-- <TD HEIGHT=30 ALIGN=left COLSPAN=3>--> <!-- <font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff">--> <!-- <U>Surgical Extractions:</U>--> <!-- </TD>--> <!-- </TR>--> <!-- <TR>--> </TABLE> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> <P></P></td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <U>ADA Code</U> </TD> <TD WIDTH="59%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <A NAME="PF"></A><U>FIXED PROSTHODONTICS PROCEDURES</U></TD> <TD WIDTH="20%" ALIGN=right><u>MEMBER FEE</u></b></TD> <TD WIDTH="20%" ALIGN=right><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"><U> USUAL FEE</U></TD> </TR> <TR> <TD ALIGN=left>D6240</TD> <TD ALIGN=left>Pontic - Porcelain fused to high noble metal</TD> <TD ALIGN=right>$ 705.00</TD> <TD ALIGN=right>$ 1,100.00</TD> </TR> <TR> <TD ALIGN=left>D6241</TD> <TD ALIGN=left>Pontic - Porcelain fused to predominantly base metal</TD> <TD ALIGN=right>$555.00</TD> <TD ALIGN=right>$800.00</TD> </TR> <TR> <TD ALIGN=left>D6242</TD> <TD ALIGN=left>Pontic - Porcelain fused to noble metal</TD> <TD ALIGN=right>$595.00</TD> <TD ALIGN=right>$795.00</TD> </TR> <TR> <TD ALIGN=left>D2750/D6750</TD> <TD ALIGN=left>Crown - Porcelain fused to high noble metal</TD> <TD ALIGN=right>$705.00</TD> <TD ALIGN=right>$1,100.00</TD> </TR> <TR> <TD ALIGN=left>D2751/D6751</TD> <TD ALIGN=left>Crown - Porcelain fused to predominantly base metal</TD> <TD ALIGN=right>$555.00</TD> <TD ALIGN=right>$825.00</TD> </TR> <TR> <TD ALIGN=left>D2752/D6752</TD> <TD ALIGN=left>Crown - Porcelain fused to noble metal</TD> <TD ALIGN=right>$595.00</TD> <TD ALIGN=right>$860.00</TD> </TR> <TR> <TD ALIGN=left>D2954/D6972</TD> <TD ALIGN=left>Post and core (prefabricated)</TD> <TD ALIGN=right>$185.00</TD> <TD ALIGN=right>$275.00</TD> </TR> <TR> <TD ALIGN=left>D2950/D6973</TD> <TD ALIGN=left>Core buildup - including pins</TD> <TD ALIGN=right>$165.00</TD> <TD ALIGN=right>$225.00</TD> </TR> <TR> <TD ALIGN=left>D2952/D6970</TD> <TD ALIGN=left>Post and core (non-gold) laboratory</TD> <TD ALIGN=right>$260.00</TD> <TD ALIGN=right>$351.00</TD> </TR> <TR> <TD ALIGN=left>D2920</TD> <TD ALIGN=left>Recement crown</TD> <TD ALIGN=right>$60.00</TD> <TD ALIGN=right>$92.00</TD> </TR> <TR> <TD ALIGN=left>D6930</TD> <TD ALIGN=left>Re-cement fixed bridge</TD> <TD ALIGN=right>$70.00</TD> <TD ALIGN=right>$97.00</TD> </TR> <TR> <TD ALIGN=left>D2999/D6999</TD> <TD ALIGN=left>Crown - Temporary (as part of crown procedure)</TD> <TD colspan="2" ALIGN=center>NO CHARGE</TD> </TR> </TABLE> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> <P></P></td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000 face="Arial, Helvetica, sans-serif"> <TR class="head"> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <U>ADA Code</U> </TD> <TD WIDTH="59%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <A NAME="PR"></A><U>REMOVABLE PROSTHODONTICS</U></TD> <TD WIDTH="20%" ALIGN=right><u>MEMBER FEE</u></b></TD> <TD WIDTH="20%" ALIGN=right><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"><U> USUAL FEE</U></TD> </TR> <TR class="head"> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=3><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <U><I>Complete Dentures:</I></U> </TD> </TR> <TR> <TD ALIGN=left>D5110</b></TD> <TD ALIGN=left> Complete Maxillary denture (includ. adjustments)</TD> <TD ALIGN=right> $825.00</TD> <TD ALIGN=right> $1,300.00</TD> </TR> <TR> <TD ALIGN=left>D5120</TD> <TD ALIGN=left> Complete Mandibular denture (includ. adjustments)</TD> <TD ALIGN=right> $825.00</TD> <TD ALIGN=right> $1,300.00</TD> </TR> <TR> <TD ALIGN=left>D5410/D5411</TD> <TD ALIGN=left> Denture adjustments (for dentures made at another office)</TD> <TD ALIGN=right> $55.00</TD> <TD ALIGN=right> $76.00</TD> </TR> <TR class="head"> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=3><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <U><I>Partial Dentures:</I></U> </TD> </TR> <TR> <TD ALIGN=left> D5211/D5212</b></TD> <TD ALIGN=left>Acrylic resin base (resin or wrought wire clasps)</TD> <TD ALIGN=right> $585.00</TD> <TD ALIGN=right> $979.00</TD> </TR> <TR> <TD ALIGN=left> D5213/D5214</b></TD> <TD ALIGN=left>Cast metal framework with resin base</TD> <TD ALIGN=right> $825.00</TD> <TD ALIGN=right> $1,389.00</TD> </TR> <!-- <TR> --> <!-- <TD ALIGN=left>--> <!-- <font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff">--> <!-- <U><I>Precision or Semi-Precision Partial</I></U>--> <!-- </TD>--> <!-- <TD ALIGN=right>&nbsp;</TD>--> <!-- <TD ALIGN=right>&nbsp;</TD>--> <!-- </TR>--> <TR class="head"> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=3><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <U><I>Denture Reline/Repair</I></U> </TD> </TR> <TR> <TD ALIGN=left> D5730/D5731</b></TD> <TD ALIGN=left>Reline denture (chairside)</TD> <TD ALIGN=right> $205.00</TD> <TD ALIGN=right> $306.00</TD> </TR> <TR> <TD ALIGN=left> D5750/D5751</b></TD> <TD ALIGN=left> Reline denture (laboratory)</TD> <TD ALIGN=right> $280.00</TD> <TD ALIGN=right> $386.00</TD> </TR> <TR> <TD ALIGN=left>D5510</b></TD> <TD ALIGN=left>Repair broken denture base (no teeth involved)</TD> <TD ALIGN=right> $110.00</TD> <TD ALIGN=right> $164.00</TD> </TR> <TR> <TD ALIGN=left>D5520</TD> <TD ALIGN=left>Replace tooth on denture</TD> <TD ALIGN=right>$90.00</TD> <TD ALIGN=right> $142.00</TD> </TR> <TR> <TD ALIGN=left>D9940</TD> <TD ALIGN=left>Occlusal guard</TD> <TD ALIGN=right>&nbsp;</TD> <TD ALIGN=right>&nbsp;</TD> </TR> <TR class="head"> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=3><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <U><I>Space Maintainers</I></U> </TD> </TR> <TR> <TD ALIGN=left><font face="Arial" size="2">D1520</b></TD> <TD ALIGN=left> Unilateral - removable</TD> <TD ALIGN=right> $240.00</TD> <TD ALIGN=right> $315.00</TD> </TR> <TR> <TD ALIGN=left><font face="Arial" size="2">D1525</b></TD> <TD ALIGN=left> Bilateral - removable</TD> <TD ALIGN=right> $290.00</TD> <TD ALIGN=right> $365.00</TD> </TR> </TABLE></td> </tr> <tr> <td><CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <P> <CENTER> <UL> <LI> <font face="arial">Please Note: Rates are Subject to Periodic Change<BR> Without Prior Notification</LI> </UL> <A href="specialist.htm">Northeast Specialist Fees</A> </CENTER></td> </tr> </table> <!--#include file="feeBottom.asp"--> </BODY> </HTML>