| Document Date: 2013-11-08 19:23:44
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City Harrisburg / / Currency USD / / Facility arch MA Fee / Cleft Palate Clinic / / IndustryTerm dental services / orthodontic services / base metal crown / periodontal services / anesthesia/sedation services / cement bases / adjunctive services / adjunctive crown services / / MedicalCondition DPW-OMAP-MA-HANDBOOK MEDICAL ASSISTANCE PROGRAM DENTAL FEE SCHEDULE CLEFT PALATE SERVICES / advanced periodontal disease / severe handicapping malocclusion / impacted tooth / Medical Assistance Programs Cleft Palate Services P.O / unerupted tooth / periodontal disease / / MedicalTreatment counseling / surgery / / Organization Department of Public Welfare office / Department of Health / Pennsylvania State Board of Dentistry / / Position eligible orthodontist / Physician / chair / D9221 Deep Sedation/General / Deep Sedation/General / surgeon / Assistant Surgeon / forward / dentist / General / patient/per dentist / certified registered nurse anesthetist / assistance surgeon / / ProvinceOrState Pennsylvania / / Technology Diagnostic Imaging / /
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MEDICAL ASSISTANCE PROGRAM DENTAL FEE SCHEDULE Dental – General Payment Policies Children under 21 years of age are eligible for all medically necessary dental services. For children under 21 years of age who require m