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INDIAN RIVER COUNTY HEALTH DEPARTMENT <br /> FEE SCHEDULE --Effective Nov.01, 2006 <br /> Dental Services(Sliding Fee Scale does not apply)CONTINUED <br /> D2931 Prefabricated Steel Crown Permanent $68.00 D7450 Cyst Removal $156.75 <br /> D2940 Sedative Filling $18.00 D7471 Removal of Exostosis $187.50 <br /> D2950 Crown Build-Up $75.00 D7510 I&D- Intraoral (Drainage Abscess) $47.00 <br /> D2951 Pin Retention-Per Tooth $2.00 D7960 Frenectomy $113.75 <br /> D2954 Prefab Post/Core in Add Crown $53.00 D9230 Analgesia(Nitrous) $35.20 <br /> D2960 Labial Veneer Chair side $169.75 D9310 Consultation $18.00 <br /> D2961 Labial Veneer+ LAB $227.50 D9630 Drugsl $19.50 <br /> D2970 Temp Crown $75.00 D9920 Behavior Management $24.00 <br /> D2971 Add procedure under partial $50.00 D9930 Unsched Post Op-Surgery $37.50 <br /> D3110 Pulp Cap Direct $13.00 D9940 Occlusal Guard- Hard $156.25 <br /> D3120 Pulp Cap Indirect $11.00 D9941 Occlusal Guard-Soft $125.00 <br /> D3220 Therapeutic Pulpotomy $50.00 D9951 Occlusal Adjustment-Limited $50.00 <br /> D3310 Root Canal (Anterior) $148.00 D9972 External Bleaching 1 $140.00 <br /> D3320 Root Canal (Bicuspid) $190.00 D9974 Internal Bleaching Per tooth $66.20 <br /> D3330 Root Canal (Molar) $235.00 Bleach Material Refill: per box <br /> D4240 Periodontal Surgery $190.50 From Patterson $25.00 <br /> D4341 Root Planning per Quadrant $40.00 From Perfecta $60.00 <br /> D4355 Full Mouth Debridement $47.50 DNLAB Dental Lab Charges $25.00 <br /> D5110 Upper Denture(Full) $390.00 <br /> D5120 Lower Denture(Full) $390.00 <br /> 10/23/2006CLFEE2006-07 Page 7 of 11 <br />