1. (a) Initial license/permit:

   1. (1) Dental license by examination, one hundred fifty dollars ($150);
   2. (2) Dental license by credentials/reciprocity, one thousand dollars ($1,000);
   3. (3) Dental specialty license, three hundred dollars ($300);
   4. (4) Collaborative Care Permit for dentists, five hundred dollars ($500);
   5. (5) Hygiene license by examination, one hundred dollars ($100);
   6. (6) Hygiene license by credentials/reciprocity, three hundred fifty dollars ($350);
   7. (7) Collaborative Care Permit I for hygienists, one hundred dollars ($100);
   8. (8) Collaborative Care Permit II for hygienists, one hundred fifty dollars ($150);
   9. (9) Corporation registration, twenty-five dollars ($25.00);
   10. (10) General/Deep Sedation Permit (Dentist), five hundred dollars ($500);
   11. (11) Moderate Sedation Permit (Dentist), one hundred fifty dollars ($150);
   12. (12) Local Anesthesia Permit (Hygienist), twenty-five dollars ($25.00);
   13. (13) Mobile Dental Facility Permit, five thousand dollars ($5,000); and
   14. (14) Exam and licensing for dental assistants, seventy-five dollars ($75.00).

2. (b) Renewal license or permit:

   1. (1) Dentist, three hundred dollars ($300);
   2. (2) Corporation registration, ten dollars ($10.00);
   3. (3) Sedation Permit (Dentists), eighty dollars ($80.00);
   4. (4) Dental hygienists, one hundred dollars, ($100);
   5. (5) Reinstatement for dentists and hygienists, two hundred dollars ($200), plus renewal fee; and
   6. (6) Dental assistant, fifty dollars ($50.00).

3. (c) Other:

   1. (1) Wall certificate remake for dentists and hygienists, twenty-five dollars ($25.00);
   2. (2) NSF (returned) check fee, twenty-five dollars ($25.00); and
   3. (3) Background checks, thirty-eight dollars and fifty cents, ($38.50).

4. (d) Fee waiver.

   1. (1) Pursuant to Acts 2021, No. 725, an applicant may receive a waiver of the initial licensure fee, if eligible.

   2. (2) Eligible applicants are applicants who:

      1. (A) Are receiving assistance through the:

5. (i) Arkansas, or current state of residence equivalent, Medicaid Program;

   1. (ii) Supplemental Nutrition Assistance Program;

      1. (iii) Special Supplemental Nutrition Program for Women, Infants, and Children;

         1. (iv) Temporary Assistance for Needy Families Program; or
         2. (v) Lifeline Assistance Program;
      2. (B) Were approved for unemployment within the last twelve (12) months; or
      3. (C) Have an income that does not exceed two hundred percent (200%) of the federal poverty income guidelines.

   2. (3)

      1. (A) Applicants shall provide documentation showing their receipt of benefits from the appropriate state agency.
      2. (B) For Medicaid, Supplemental Nutrition Assistance Program, Special Supplemental Nutrition Program for Women, Infants, and Children, Temporary Assistance for Needy Families Program, or Lifeline Assistance Program, documentation from the Department of Human Services or current state of residence equivalent agency.
      3. (C) For unemployment benefits approval in the last twelve (12) months, the Division of Workforce Services or current state of residence equivalent agency.
      4. (D) For proof of income, copies of all Internal Revenue Service forms indicating applicant’s total personal income for the most recent tax year, e.g., “W-2”, “1099”, etc.
   3. (4) Applicants shall attest that the documentation provided under subdivision (d)(3) of this section is a true and correct copy, and fraudulent or fraudulently obtained documentation shall be grounds for denial or revocation of license.

Codification Notes: "NSF" means nonsufficient funds.