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H <br />Z <br />W <br />• 0 <br />N <br />Q ' <br />CL <br />W <br />.• 0 <br />�o0 <br />0 <br />= r„ <br />w <br />O J <br />c� <br />w <br />Z <br />Q <br />• W <br />Z <br />8 <br />8 <br />1.) <br />RESOLUTION 2007-136 <br />oN <br />U) 0 <br />c,V• <br />8 <br />v} <br />8 <br />tt <br />0 <br />EH <br />8 <br />6;9 <br />8 <br />88 <br />M M <br />EA 69 <br />00 <br />ala <br />t!} <br />0 <br />Ef} <br />0 <br />8 <br />(h <br />d4 <br />8 <br />8 <br />Eft <br />0 <br />CNIEftti <br />8 <br />88 <br />as <br />ER <br />8 <br />ER <br />Hi <br />8 <br />0) <br />EA) <br />8 <br />CO <br />8 <br />8 <br />ER <br />8 <br />N <br />0 <br />U) <br />77, <br />ER <br />8 <br />0 <br />0 <br />co <br />b} <br />8 <br />0 <br />co <br />ER <br />0 <br />n <br />a <br />0 <br />_M <br />• <br />O <br />w <br />O <br />COC <br />a <br />9 6/2007CLFEE2007-08 FINAL <br />1 <br />1 <br />05213 Maxillary Partial Denture (Cast Metal) <br />D5214 Mandibular Partial Denture (Cast Metal) <br />D5281 Removable Unilateral Partial Denture <br />D5520 Replace Teeth Complete Denture + LAB <br />D5640 Replace Teeth - Partial Denture + LAB <br />D5650 Add Tooth to Existing Denture + LAB <br />D5660 Add Clasp to Partial Denture + LAB <br />D5730 Reline Complete Max - Chairside <br />a <br />+ <br />D5212 Lower Partial - Resin Base <br />D5410 Adjust Complete Denture - Max <br />05411 Adjust Complete Denture - Mand <br />D5421 Adjust Partial Denture - Max <br />D5422 Adjust Partial Denture - Mand <br />D5510 Repair Complete Denture - Base <br />05731 Reline Complete Mand - Chairsid( <br />05750 Reline Complete Max + LAB <br />D5751 Reline Complete Mand + LAB <br />D5810 Interim Prosthetic Visit - N/C (INTI <br />D5820 Interim Partial Denture (Upper FIiF <br />D5821 Interim Partial Denture (Lower FIiF <br />D7111 N Coron Remnants -Deciduous <br />D7140 Ext. Erupted Tooth or <br />D7160 Sched Surg Post Op <br />07210 Surgical Erupted <br />D7220 Surg Ext -Soft Tissue Impact <br />D7230 Surg Ext -Part. Bony Impact <br />D7240 Surg Ext -Part. Bony Impact <br />D7241 Surg Ext -Comp Bony Unusual <br />D7250 Root Recovery -Surgery <br />07270 Tooth Reimplant/Stabilization <br />D7280 Surg Exposure to Aid Eruption <br />D7285 Biopsy - Hard Tissue + LAB <br />D7286 Biopsy - Soft Tissue + LAB <br />D7288 Brush Biopsy + LAB <br />D7310 Alveoloplasty w/Extraction <br />D7320 Alveoloplasty No Extraction <br />D7410 Surgical Excision<1.25cm + LAB 1 <br />D7420 Surgical Excision>1.25cm + LAB I <br />D7510 I & D - Intraoral (Drainage Abcess) <br />. <br />D9110 Palliative Services <br />D9230 Analgesia (Nitrous) <br />000o000000000000000 <br />0ODOD0 cv N'or; cid, 06N-6NaC V �a0�(O <br />- a- •-a- M e- MN <br />11.00 <br />6.00 <br />13.00 <br />72.00 <br />117.00 <br />17.00 <br />31.00 <br />41.00 <br />51.00 <br />61.00 <br />34.00 <br />39.00 <br />44.00 <br />72.00 <br />00 <br />I -C') <br />41.00 <br />o <br />0 <br />84.75 <br />000 <br />(p CD 0 <br />'f0r- <br />N <br />O <br />M <br />of <br />LIU u cv ref iuuic ural txam tmeaicaia Ketum) <br />D0140 Limited Oral Exam (EMER) <br />D0150 Comprehensive Exam (Medicaid) <br />D0170 Re-Eval Limited (Est. Pt.) <br />O 0210 Intra Oral Complete Sen (inc BW) <br />D0220 PA Single -First <br />00230 PA -Each Additional <br />O 0240 Intra Oral -Occlusal <br />D0270 Bitewings -Single L or R <br />D0272 Bitewings -Two <br />O 0274 Bitewings -Four <br />D0330 Panoramic Film <br />O 0470 Diagnostic Cast <br />D1110 Prophylaxis - Adult 14+ <br />uizuti t-IuOnde Vamish <br />D1330 Oral Hygiene Instruction <br />D1351 Sealant - Per Tooth 3, 14, <br />D1510 Space Main-Fixed-Unilat <br />D1515 Space Main-Fixed-Bilat <br />D1550 Recement Space Maint <br />D2140 AM 1 Surf - <br />D2150 AM 2 Surf - <br />D2160 AM 3 Surf - <br />02161 AM 4 Surf - <br />D2330 Comp Resin -One Surface -Ant <br />D2331 Comp Two Surface Ant <br />D2332 Comp Three Surface Ant <br />D2335 Com Incisal Angle + 4 Surf <br />C <br />< 't 't `t <br />Einincn <br />C C <br />y co y <br />M M <br />(V N N <br />c) D en <br />C <br />y <br />cc) <br />N <br />D <br />N <br />+ O + <br />'C <br />7) 0 <br />n�.0 o <br />C <br />y (p . <br />0To1 <br />v5 <br />ii c <br />NNOC <br />N. t -C <br />N N N C <br />cn en c) C <br />vLULV r'ecxrneni l,rown <br />02930 Stainless Steel - Primary <br />• <br />O <br />w <br />O <br />COC <br />a <br />9 6/2007CLFEE2007-08 FINAL <br />