<!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 6.00.2900.2523" name=GENERATOR> </HEAD><BODY style="font-family:Arial, Helvetica, sans-serif; font-size:13px; font-weight:bold;"> <table> <tr> <td><CENTER> <FONT SIZE="+1" FACE="Arial" COLOR="#0000ff"><FONT size=3><STRONG>Northeast General Dentists<BR> Fee Schedule II</STRONG></FONT><FONT face="Arial, Helvetica, sans-serif" size=2><BR> <STRONG><FONT color=#FF0000><FONT size=2>As of </FONT>March 1, 2007</FONT><BR> <FONT color=#000000>(all procedures as performed by a general Dentist)</FONT></STRONG></FONT> </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 CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDERCOLOR=#000000 BORDER=0 style="font-family:Arial, Helvetica, sans-serif; font-size:13px; font-weight:bold;"> <TR> <td align="left" width="6%"><font face="Arial, Helvetica, sans-serif" color="#0000ff" size="2"><b> <u>ADA Code</u> </b></font></td> <TD WIDTH="59%" ALIGN=left><A NAME="DPP"></A><B><FONT SIZE=2 FACE="Arial" COLOR="#0000ff"><U>DIAGNOSTIC &amp; PREVENTATIVE PROCEDURES</U></FONT></B></TD> <TD WIDTH="20%" ALIGN=right><B><FONT SIZE=2 FACE="Arial" COLOR="#0000ff"><U>MEMBER FEE</U></FONT></B></TD> </TR> <TR> <td align="left"><strong>D0150</strong></td> <TD ALIGN=left>Comprehensive oral evaluation - new or established</TD> <TD ALIGN=center>NO CHARGE*</TD> </TR> <TR> <td align="left">D0120</td> <TD ALIGN=left>Periodic oral evaluation - established patient</TD> <TD ALIGN=center>NO CHARGE*</TD> </TR> <TR> <td align="left">D0140</td> <TD ALIGN=left>Consultation (limited oral evaluation - problem focused)</TD> <TD ALIGN=right>$45.00</TD> </TR> <TR> <td align="left">D0220</td> <TD ALIGN=left>Single x-ray (any type)</TD> <TD ALIGN=right>$14.00</TD> </TR> <TR> <td align="left">D0210</td> <TD ALIGN=left>X-rays (up to full mouth, or at least 3 films taken)</TD> <TD ALIGN=right>$45.00</TD> </TR> <TR> <td align="left">D0330</td> <TD ALIGN=left>X-rays - Panoramic film</TD> <TD ALIGN=right>$50.00</TD> </TR> <TR> <td align="left">D1110</td> <TD ALIGN=left>Adult cleaning, polishing and scaling</TD> <TD ALIGN=right>$60.00</TD> </TR> <TR> <td align="left">D1120</td> <TD ALIGN=left>Child cleaning and polishing - excluding flouride</TD> <TD ALIGN=right>$40.00</TD> </TR> <TR> <td align="left">D1203</td> <TD ALIGN=left>Topical fluoride treatment for children</TD> <TD ALIGN=right>$22.00</TD> </TR> <TR> <td align="left">D9110</td> <TD ALIGN=left>Palliative (emergency) treatment of dental pain</TD> <TD ALIGN=right>$40.00</TD> </TR> <TR> <td align="left">D1351</td> <TD ALIGN=left>Sealant - per tooth</TD> <TD ALIGN=right>$30.00</TD> </TR> <TR> <td align="left">&nbsp;</td> <TD ALIGN=left>&nbsp;</TD> <TD ALIGN=right>&nbsp;</TD> </TR> <B> </B> </TABLE> <p></p> <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> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <B><U>ADA Code</U> </B> </font></TD> <TD WIDTH="59%" ALIGN=left><A NAME="RP"></A><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><U>RESTORATIVE PROCEDURES (FILLINGS)</U></B></FONT></TD> <TD WIDTH="20%" ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><FONT SIZE=2 FACE="Arial" COLOR="#0000ff"><U>MEMBER</U></FONT><U> FEE</U></B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2951</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Pin retention - per tooth</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$32.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2940</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Sedative filling</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$44.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;</font></b></td> <TD HEIGHT=30 ALIGN=left COLSPAN=2><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <B><U>Silver Amalgams: <I>Permanent</I></U></B></font> </TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2140</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>One Surface</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$55.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2150</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Two Surfaces</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$68.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2160</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Three Surfaces</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$80.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2161</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Four Surfaces or more</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$110.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;</font></b></td> <TD HEIGHT=30 ALIGN=left COLSPAN=2><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <B><U>Composite resins: Anterior Composites:</U></B></font> </TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2330</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>One Surface</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$69.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2331</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Two Surfaces</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$83.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2332</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Three Surfaces</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$104.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2335</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Four or more surfaces</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$134.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;</font></b></td> <TD HEIGHT=30 ALIGN=left COLSPAN=2><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"><B><U>Posterior composites:</U></B></font> </TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2391</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>One Surface</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$75.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2392</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Two Surfaces</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$96.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2393</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Three Surfaces </B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$123.00</B></FONT></TD> </TR> <TR> <td align="left"><b> <font face="Arial, Helvetica, sans-serif" size="2">&nbsp;D2394</font></b></td> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Four or more surfaces</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$135.00</B></FONT></TD> </TR> </TABLE> <p></p> <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> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <B><U>ADA Code</U></B> </font></TD> <TD WIDTH="59%" ALIGN=left><A NAME="CP"></A><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><U>COSMETIC PROCEDURES</U></B></FONT></TD> <TD WIDTH="20%" ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><FONT SIZE=2 FACE="Arial" COLOR="#0000ff"><U>MEMBER</U></FONT><U> FEE</U></B></FONT></TD> </TR> <TR> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=2><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <B><U>Bonding/Veneers (per tooth)</U></B></font> </TD> </TR> <TR> <TD ALIGN=left><FONT face=Arial size=2><STRONG>D2960</STRONG></FONT></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Labial veneer (resin) - chairside</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$240.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2"><b>D2962</b></font></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Labial veneer (porcelain) - laboratory</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$480.00</B></FONT></TD> </TR> </TABLE> <p></p> <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> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <B><U>ADA Code</U></B> </font></TD> <TD WIDTH="59%" ALIGN=left><A NAME="E"></A><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><U> ENDODONTICS PROCEDURES</U></B></FONT></TD> <TD WIDTH="20%" ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><FONT SIZE=2 FACE="Arial" COLOR="#0000ff"><U>MEMBER</U></FONT><U> FEE</U></B></FONT></TD> </TR> <TR> <TD ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2"><b>D3110</b></font></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Pulp capping - (excl. final restoration)</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$35.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D3220</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Pulpotomy (excl. final restoration)</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$70.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=29><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <B><U>Root Canal Therapy (excl. final restoration)</U></B></font> </TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D3310</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Anterior</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$355.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D3320</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Bicuspid</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$410.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D3330</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Molar</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$510.00</B></FONT></TD> </TR> </TABLE> <p></p> <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 style="font-family:Arial, Helvetica, sans-serif; font-size:13px; font-weight:bold;"> <TR> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <B><U>ADA Code</U></B> </font></TD> <TD WIDTH="59%" ALIGN=left><A NAME="P"></A> <FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><U> PERIODONTICS PROCEDURES</U></B></FONT> </TD> <TD WIDTH="20%" ALIGN=right><FONT FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><FONT SIZE=2 FACE="Arial" COLOR="#0000ff"><U>MEMBER</U></FONT><U> FEE</U></B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D4341</font></b></TD> <TD ALIGN=left>Periodontal scaling and root planing<br> (per quadrant)</TD> <TD ALIGN=right><FONT FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$75.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D4260</font></b></TD> <TD ALIGN=left>Osseous or mucogingival surgery (per quadrant)</TD> <TD ALIGN=right><FONT FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$485.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D4910</font></b></TD> <TD ALIGN=left><FONT FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Perio maintenance</B></FONT></TD> <TD ALIGN=right><FONT FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$65.00</B></FONT></TD> </TR> </TABLE> <p></p> <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> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <B><U>ADA Code</U></B> </font></TD> <TD WIDTH="59%" ALIGN=left><A NAME="O"></A><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><U> ORAL SURGERY&nbsp;PROCEDURES&nbsp;</U></B></FONT></TD> <TD WIDTH="20%" ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><FONT SIZE=2 FACE="Arial" COLOR="#0000ff"><U>MEMBER</U></FONT><U> FEE</U></B></FONT></TD> </TR> <!-- <TR> --> <!-- <TD HEIGHT=30 ALIGN=left COLSPAN=3>--> <!-- <font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff">--> <!-- <B><U>Extraction: --> <!-- Simple</U></B></font>--> <!-- </TD>--> <!-- </TR>--> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D7110</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Extraction, coronal remnants - deciduous tooth</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$60.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D7140</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Extraction, erupted tooth or exposed root</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$65.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D7210</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Surgical Extraction</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$100.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D7220</font></b></TD> <td align=left><font size="2" face="Arial" color="#000000"><b>Extraction - soft tissue impaction</b></font></td> <td align=right><font size="2" face="Arial" color="#000000"><b>$155.00</b></font></td> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D7230</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Extraction - partial bony impaction</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$195.00</B></FONT></TD> </TR> <!-- <TR> --> <!-- <TD HEIGHT=30 ALIGN=left COLSPAN=3>--> <!-- <font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff">--> <!-- <B><U>Surgical --> <!-- Extractions:</U></B></font>--> <!-- </TD>--> <!-- </TR>--> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D7240</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Extraction - full bony impaction</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$240.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D7510</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Incision and drainage of abscess</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$70.00</B></FONT></TD> </TR> </TABLE> <p></p> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> <P></P></td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 style="font-family:Arial, Helvetica, sans-serif; font-size:13px; font-weight:bold;"> <TR> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <B><U>ADA Code</U></B> </font></TD> <TD WIDTH="59%" ALIGN=left><A NAME="PF"></A><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><U>FIXED PROSTHODONTICS PROCEDURES</U></B></FONT></TD> <TD WIDTH="20%" ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><FONT SIZE=2 FACE="Arial" COLOR="#0000ff"><U>MEMBER</U></FONT><U> FEE</U></B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D6240</font></b></TD> <TD ALIGN=left>Pontic - Porcelain fused to high noble metal</TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$ 600.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left>D6241</TD> <TD ALIGN=left>Pontic - Porcelain fused to predominantly base metal</TD> <TD ALIGN=right>$515.00</TD> </TR> <TR> <TD ALIGN=left>D6242</TD> <TD ALIGN=left>Pontic - Porcelain fused to noble metal</TD> <TD ALIGN=right>$595.00</TD> </TR> <TR> <TD ALIGN=left>D2750/D6750</TD> <TD ALIGN=left>Crown - Porcelain fused to high noble metal</TD> <TD ALIGN=right>$600..00</TD> </TR> <TR> <TD ALIGN=left>D2751/D6751</TD> <TD ALIGN=left>Crown - Porcelain fused to predominantly base metal</TD> <TD ALIGN=right>$515.00</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> </TR> <TR> <TD ALIGN=left>D2954/D6972</TD> <TD ALIGN=left>Post and core (prefabricated)</TD> <TD ALIGN=right>$158.00</TD> </TR> <TR> <TD ALIGN=left>D2950/D6973</TD> <TD ALIGN=left>Core buildup - including pins</TD> <TD ALIGN=right>$135.00</TD> </TR> <TR> <TD ALIGN=left>D2952/D6970</TD> <TD ALIGN=left>Post and core (non-gold) laboratory</TD> <TD ALIGN=right>$233.00</TD> </TR> <TR> <TD ALIGN=left>D2920</TD> <TD ALIGN=left>Recement crown</TD> <TD ALIGN=right>$45.00</TD> </TR> <TR> <TD ALIGN=left>D6930</TD> <TD ALIGN=left>Re-cement fixed bridge</TD> <TD ALIGN=right>$54.00</TD> </TR> <TR> <TD ALIGN=left>D2999/D6999</TD> <TD ALIGN=left>Crown - Temporary (as part of crown procedure)</TD> <TD ALIGN=right>NO CHARGE </TD> </TR> </TABLE> <p></p> <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> <TD WIDTH="6%" ALIGN=left><font face="Arial, Helvetica, sans-serif" size="2" COLOR="#0000ff"> <B><U>ADA Code</U></B> </font></TD> <TD WIDTH="59%" ALIGN=left><A NAME="PR"></A><FONT SIZE="2" FACE="Arial" COLOR="#0000ff"><B><U>REMOVABLE PROSTHODONTICS PROCEDURES</U></B></FONT></TD> <TD WIDTH="20%" ALIGN=right><B><FONT SIZE=2 FACE="Arial" COLOR="#0000ff"><U>MEMBER</U></FONT><U><font size="2" face="Arial" color="#0000ff"> </font><FONT SIZE="2" FACE="Arial" COLOR="#0000ff">FEE</FONT></U></B></TD> </TR> <TR> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=2><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <B><U><I>Complete Dentures</I></U></B></font> </TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D5110</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Complete maxillary denture (includ. adjustments)</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$700.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D5120</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Complete Mandibular denture (including adjustments)</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$700.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D5410/D5411</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Denture adjustments (for dentures made at another office)</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$45.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=2><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <B><U><I>Partials Dentures:</I></U></B></font> </TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2"> D5211/D5212</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Acrylic resin base (resin or wrought wire clasps)</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$485.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2"> D5213/D5214</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Cast metal framework with resin base</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$640.00</B></FONT></TD> </TR> <!-- <TR> --> <!-- <TD ALIGN=left>--> <!-- <font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff">--> <!-- <B><U><I>Precision --> <!-- or Semi-Precision Partial</I></U></B></font>--> <!-- </TD>--> <!-- </TR>--> <TR> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=2><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <B><U><I>Denture Reline/Repair:</I></U></B></font> </TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2"> D5730/D5731</font></b></TD> <TD ALIGN=left><strong>Reline denture (chairside)</strong></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$175.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2"> D5750/D5751</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Reline denture (laboratory)</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$225.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial, Helvetica, sans-serif" size="2">D5510</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Repair broken denture base (no teeth involved)</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$100.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial" size="2">D5520</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Replace tooth on denture</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$85.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial" size="2">D9940</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Occlusal guard</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$320.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left>&nbsp;</TD> <TD HEIGHT=30 ALIGN=left COLSPAN=2><font size="2" face="Arial, Helvetica, sans-serif" color="#0000ff"> <B><U><I>Space Maintainers</I></U></B></font> </TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial" size="2">D1520</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Unilateral - removable</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$217.00</B></FONT></TD> </TR> <TR> <TD ALIGN=left><b><font face="Arial" size="2">D1525</font></b></TD> <TD ALIGN=left><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>Bilateral - removable</B></FONT></TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000"><B>$275.00</B></FONT></TD> </TR> </TABLE> <p></p></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" COLOR="#000000"><B>Please Note: Rates are Subject to Periodic Change<BR> Without Prior Notification</B></FONT></LI> </UL> <A href="specialist.htm">Northeast Specialist Fees</A> </CENTER></td> </tr> </table> <!--#include file="feeBottom.asp"--> </BODY> </HTML>