Cal. Code Regs. tit. 22, § 51506.1
(b) Maximum Allowances
Code
Maximum Allowances
DIAGNOSTIC SERVICES
9950
Clinical Examination and Consultation, Including Study Models
$51.99
9952
Prosthetic Evaluation and Treatment Plan, Including Study Models
74.33
9955
TMJ Series radiographs
81.34
9956
Cephalometric Head Film, single, first film, Including tracing
22.48
9957
Cephalometric Head Film, Each Additional film, Including tracing
4.56
MAXILLOFACIAL PROSTHETIC SERVICES
9960
Speech appliance transitional with or without pharyngeal extension
$593.76
9962
Speech appliance, permanent, edentulous, with or without pharyngeal extension
1,115.78
9964
Speech appliance, permanent, partially edentulous, cast framework, with or without pharyngeal extension
1,190.11
9966
Palatal lift, interim
595.07
9968
Palatal lift, permanent, cast framework
1,115.78
9970
Obturator immediate surgical, routine
669.52
9971
Obturator immediate surgical, complex
892.66
9972
Obturator permanent, complex
1,190.11
9973
Resection prosthesis, permanent edentulous, complex
1,190.11
9974
Resection prosthesis, permanent edentulous, routine
1,041.46
9975
Resection prosthesis, permanent, partially edentulous, complex
1,338.92
9976
Repositioner, mandibular, two piece
1,785.33
9977
Removal facial prosthesis
By Report
9978
Splints and stents
By Report
9979
Radiation therapy fluoride carrier
59.00
9980
Repairs, maxillofacial prosthesis
By Report
9981
Rebase laboratory processed, maxillofacial prosthesis
By Report
9982
Balancing (opposing) maxillofacial prosthesis
By Report
MAXILLOFACIAL SURGICAL PROCEDURES
9985
Maxillofacial surgical procedures
By Report
TEMPOROMANDIBULAR JOINT DYSFUNCTION MANAGEMENT
9990
Occlusal analysis, including report and/or models
$89.81
9992
Occlusal adjustments, limited centric and excursive adjustments including records and/or models
44.96
9994
Occlusal balancing, altering centric relation, including records and/or models
238.59
9995
Orthopedic stabilizing appliance, disocclusion splint
210.49
9996
Postoperative visits, symptomatic care and counseling
36.52
9998
Unlisted therapeutic service
By Report
Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 14105, Welfare and Institutions Code; and Statutes of 1989, Chapter 93, Items 4260-106-001 and 890.
1. Amendment filed 8-7-89 as an emergency; operative 8-7-89 (Register 89, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 12-5-89. For prior history, see Register 85, No. 52.
2. Certificate of Compliance transmitted to OAL 12-1-89 and filed 1-2-90 (Register 90, No. 2).