Office of Medical Assistance Programs; Fee Increase for Selected Dental Services By this notice, the Department of Public Welfare announces that the fees for the following pediatric dental services are increased, effective January 1, 1999 as follows:
Procedure Increased Fee Code Description Current Fee Effective 1-1-1999 D0120 Periodic Oral Examination $13.00 $17.00 D0220 Intraoral--Periapical--First Film 4.00 7.00 D0230 Intraoral--Periapical-- 4.00 7.00 Each Additional Film D0240 Intraoral--Occlusal Film 6.00 12.00 D0270 Bitewings--One Film 4.00 7.00 D0272 Bitewings--Two Films 8.00 14.00 D0330 Panoramic Film 24.00 35.00 D1110 Prophylaxis--Adult 21.00 30.00 D1120 Prophylaxis--Child 17.00 22.00 D1351 Topical Application of Sealants, 14.00 25.00 Per Tooth D1203 Topical Application of Fluoride 10.00 17.00 (Excluding Prophylaxis)--Child D1510 Space Maintainer--Unilateral Fixed 57.00 120.00 D1515 Space Maintainer--Bilateral Fixed 92.00 190.00 D1550 Recementation of Space Maintainer 10.00 30.00 D2110 Amalgam Restoration--One Surface, 20.00 40.00 Primary D2120 Amalgam Restoration--Two Surfaces, 27.00 50.00 Primary D2130 Amalgam Restoration--Three Surfaces, 34.00 60.00 Primary D2140 Amalgam Restoration--One Surface, 20.00 40.00 Permanent D2150 Amalgam Restoration--Two Surfaces, 27.00 50.00 Permanent D2160 Amalgam Restoration--Three Surfaces, 34.00 60.00 Permanent D2330 Resin--One Surface 20.00 45.00 D2331 Resin--Two Surfaces 27.00 55.00 D2332 Resin--Three Surfaces 34.00 60.00 D2336 Resin Strip--Crown Acid Etch 84.00 145.00 (Anterior Teeth Only) D2338 Facing Cut Into SSC (Window)-- 34.50 60.00 Separate Appointment (Primary Teeth Only) D2930 Prefabricated Stainless Steel Crown, 55.00 90.00 Primary Tooth D2933 Prefabricated Stainless Steel Crown 84.00 145.00 with Resin Window D3220 Therapeutic Pulpotomy (Excluding 33.00 50.00 Final Restoration) X3321 Root Canal Therapy, Bicuspid, 88.00 150.00 Paste RC Filling Material (TOS OE) X3331 Root Canal Therapy, Molar, Paste RC 133.00 180.00 Filling Material D7110 Tooth Extraction 21.00 45.00 D7120 Tooth Extraction--Each Additional Tooth 21.00 45.00 X9631 Conscious Sedation (Oral/IM Sedation) 58.50 95.00 X9632 Nitrous Oxide/Oxygen Analgesic 20.00 30.00 X6940 Management Fee (For difficult to manage 20.00 30.00 persons with developmental disabilities) X1516 Unilateral Space Maintainer, Distal Shoe 67.00 160.00 D2337 Acid Etch Bandage 27.00 60.00 D2931 Prefabricated Stainless Steel Crown, 55.00 110.00 Permanent Tooth D9110 Palliative (Emergency) Treatment of 12.00 30.00 Dental Pain--Minor Procedures X5261 Kiddie Partial Fixed 0-6 Yrs of Age 175.00 275.00 D7270 Tooth Reimplantation and Stabilization of 80.00 320.00 Accidentally Avulsed or Displaced Tooth and/or Alveolus (<20) D7960 Frenulectomy--Separate Procedure 40.00 80.00 D7970 Excision of Hyperplastic Tissue--Per Arch 35.00 80.00 The fiscal note was prepared under provision of Section 612 of The Administrative Code of 1929 (71 P. S. § 232).
Contact Person
A copy of this notice is available for review at local County Assistance Offices. Interested persons are invited to submit written comments to this notice within 30 days of this publication. These comments should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Regulations Coordinator, Room 515 Health and Welfare Building, Harrisburg, PA 17120.
Persons with a disability may use the AT&T Relay service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (Voice users). Persons who require another alternative should contact Thomas Vracarich in the Office of Legal Counsel at (717) 783-2209.
FEATHER O. HOUSTOUN,
SecretaryFiscal Note: 14-NOT-212. (1) General Fund; (2) Implementing Year 1998-99 is $1.548 Million; (3) 1st Succeeding Year 1999-00 is $2.741 Million; 2nd Succeeding Month 2000-01 is $2.768 Million; 3rd Succeeding Year 2001-02 is $2.796 Million; 4th Succeeding Year 2002-03 is $2.824 Million; 5th Succeeding Year 2003-04 is $2.852 Million; (4) 1997-98 Program--$662.740 Million; 1996-97 Program--$798.836 Million; 1995-96 Program--$792.293 Million; (7) Medical Assistance--Outpatient; (8) recommends adoption. There will be funds available in the Department's budget to cover the cost of this fee adjustment.
[Pa.B. Doc. No. 99-1103. Filed for public inspection July 9, 1999, 9:00 a.m.]
