JUNE 2001
TO:
BUFFALO TEACHERS
FROM: SUPPLEMENTAL BENEFIT FUND
THE TRUSTEES OF THE SBF HAVE AUTHORIZED SWEEPING INCREASES IN THE DENTAL REIMBURSEMENT SCHEDULE. THE NEW INCREASES WILL TAKE EFFECT FOR DENTAL WORK PERFORMED ON OR AFTER JULY 1, 2001. PLEASE SEE THE ATTACHED FOR THE SPECIFICS.
THESE CHANGES AFFECT OVER 100 DENTAL PROCEDURES AND WILL INCREASE BY OVER $250,000.00 THE AMOUNT OF MONEY THE SBF REIMBURSES TO TEACHERS FOR DENTAL CLAIMS ANNUALLY.
THE FOLLOWING IS AN EXPLANATION OF EACH COLUMN ON THE ATTACHED SHEET.
ADA# - THIS REPRESENTS THE CODES FOR EACH DENTAL PROCEDURE
DESCRIPTION - THIS EXPLAINS EXACTLY WHICH PROCEDURE EACH ADA# REPRESENTS
NEW REIMB. - THIS REPRESENTS THE NEW MAXIMUM AMOUNT THE SBF WILL PAY PER ADA#
AVE. CHARGE - THIS REPRESENTS THE AVERAGE FEE DENTISTS SUBMITTED TO THE BTF/SBF FOR EACH DENTAL PROCEDURE DURING THE CALENDAR YEAR 2000
ANNUAL
ADD. - THIS REPRESENTS THE ANNUAL COST
ADDITIONAL COST TO THE SBF FOR EACH
INCREASE.
SBF TRUSTEES: PHIL RUMORE, SUE TRAVIS, THOMAS GIAMBRA, DOLLETHA HOLMES, STEPHEN PARADA,
SBF
DIRECTOR: DAVID S. WALKER
BTF/SBF DENTAL CHANGES EFFECTIVE JULY 1, 2001
| #1 ADA# |
#2 DESCRIPTION |
#3 NEW BTF REIMBURSEMENT |
#4 AVERAGE CHARGE BY DENTIST** |
#5 ADDITIONAL COST TO SBF |
| #1 0120 0140 0150 0210 0220 0230 0240 0250 0260 0270 0272 0274 0330 0340 0460 0470 1110 1120 1203 1204 1351 1510 1515 2110 2120 2130 2140 2150 2160 2161 2330 2331 2332 2335 2381 2382 2385 2386 2387 2710 2740 2750 2910 2920 2940 2950 2960 2962 3110 3120 3220 3310 3320 3330 3351 3410 3421 3425 3430 3960 5110 5120 5130 5140 5211 5212 5281 5410/11 5421/22 5510 5520 5630 5640 5650 6210 6240 6250 6545 6720 6750 6930 6940 7110/20 7210 7220 7230 7240 7250 7310/20 7510 9110 9220 9230 9241 9310 9610 9910 |
#2 PERIODIC ORAL EXAM LIMITED ORAL EVALUATION COMPREHENSIVE ORAL EVALUATION X RAY INTRAORAL COMPLETE SER. X RAY INTRAORAL PERIAPICAL 1ST FILM X RAY " EA. ADD. FILM X RAY " OCCLUSAL FILM EXTRAORL - FIRST FILM X RAY " EA. ADD. FILM X RAY BITEWING SINGLE FILM X RAY " TWO FILMS X RAY " FOUR FILMS X RAY PANORAMIC FILM X RAY CEPHALOMETRIC FILM PULP VITALITY TESTS DIAGNOSTIC CASTS PROPHYLAXIS - ADULT CLEANING PROPHYLAXIS - CHILD CLEANING FLUORIDE TREATMENT - CHILD FLUORIDE TREATMENT - ADULT SEALANT - PER TOOTH SPACE MAINTAINER - FIXED UNILATER. SPACE MAINTAINER - FIXED BILATER. AMALGAM FILLING 1 SURF. PRIMARY AMALGAM FILLING 2 SURF. PRIMARY AMALGAM FILLING 3 SURF. PRIMARY AMALGAM FILLING 1 SURF. PERMAN. AMALGAM FILLING 2 SURF. PERMAN. AMALGAM FILLING 3 SURF. PERMAN. AMALGAM FILLING 4 SURF. PERMAN. RESIN FILLING 1 SURFACE ANTERIOR RESIN FILLING 2 SURFACE ANTERIOR RESIN FILLING 3 SURFACE ANTERIOR RESIN 4+ SUR. WITH INCISAL ANGLE RESIN-2 SURF. POSTEIOR-PRIMARY RESIN-3+ SURF. POSTERIOR-PRIMARY RESIN FILLING 1 SURF. POST/PERM. RESIN FILLING 2 SURF. POST/PERM. RESIN FILLING 3+ SURF. POST/PERM. CROWN - RESIN (LABORATORY) CROWN RESIN/HIGH NOBLE METAL CROWN PORCL. FUSED TO " " " RECEMENT INLAY RECEMENT CROWN SEDATIVE FILLING/ TEMPORARY CORE BUILDUP TO CROWN + PINS LAMINATED VENEER/LABIAL LAMINATED VENEER PORCELAIN PULP CAP - DIRECT PULP CAP - INDIRECT THERAPEUTIC PULPOTOMY ROOT CANAL THERAPY ANTERIOR ROOT CANAL THERAPY BICUSPID ROOT CANAL THERAPY MOLAR APEXIFICATION/RECALCIF. INITI. VISIT APICOECTOMY/PERIRAD. SURGERY APICOECTOMY/PERIRAD. SURGERY APICOECTOMY/PERIRAD. SURGERY RETROGRADE FILLING PER ROOT BLEACHING OF DISCOLORED TOOTH DENTURE - COMPLETE MAXILLARY DENTURE - COMPLETE MANDIBULAR DENTURE - IMMEDIATE MAXILLARY DENTURE - IMMEDIATE MANDIBULAR MAXILLARY PARTIAL DENTURE MANDIBULAR PARTIAL DENTURE REMOVABLE PARTIAL DENTURE ADJUST COMPLETE DENTURE ADJUST PARTIAL DENTURE REPAIR BROKEN COMPL. DENTURE REPLACE MISSING/BROKEN TOOTH REPAIR OR REPLACE BROKEN CLASP REPLACE BROK. TOOTH PER DENTURE ADDING 1 TOOTH TO PART. DENTURE FIXED PART. DENT. PONTIC HI NOBL. FIX. PART. PORCEL. PONTIC FUSED FIX. PART. RESIN PONTIC FUSED MET. MARYLAND BRIDGE CROWN RESIN/HIGH NOBLE METAL CROWN PORCELAIN FUSED TO MET. RECEMENT FIXED PARTIAL DENTURE FIX DENTURE - STRESS BREAKER SIMPLE EXTRACTION PER TOOTH REMOVE ERUPTED TOOTH REMOVE IMPACTED TOOTH SOFT TIS. REMOVE IMPACT TOOTH PART. BONE REMOVE IMPACT TOOTH COMP.BONE SURGICAL REMOVAL/TOOTH ROOTS ALVEOLOPLASTY SURG. PREP. PROC. INCISION & DRAINAGE OF ABSCESS EMERGENCY TREATMENT OF PAIN GENERAL ANESTHESIA FIRST 30 MIN. INHALATION OF NITROUS OXIDE INTRAVENOUS SEDATION CONSULTATION/OUTSIDE DENTIST THERAPEUTIC DRUG INJECTION DESENSITIZING APPLICATION |
#3 $16.00 $20.00 $20.00 $40.00 $8.00 $6.00 $12.00 $15.00 $10.00 $8.00 $14.00 $20.00 $35.00 $30.00 $15.00 $35.00 $27.00 $20.00 $15.00 $18.00 $18.00 $90.00 $100.00 $40.00 $45.00 $50.00 $40.00 $45.00 $50.00 $60.00 $45.00 $50.00 $60.00 $75.00 $50.00 $60.00 $45.00 $50.00 $65.00 $250.00 $340.00 $340.00 $25.00 $25.00 $30.00 $85.00 $100.00 $260.00 $20.00 $15.00 $40.00 $240.00 $275.00 $350.00 $200.00 $175.00 $200.00 $225.00 $60.00 $45.00 $350.00 $350.00 $375.00 $375.00 $200.00 $200.00 $400.00 $25.00 $25.00 $50.00 $40.00 $80.00 $40.00 $55.00 $275.00 $250.00 $225.00 $175.00 $300.00 $340.00 $40.00 $75.00 $45.00 $70.00 $75.00 $100.00 $110.00 $80.00 $80.00 $40.00 $30.00 $75.00 $35.00 $100.00 $25.00 $15.00 $15.00 |
#4 $24.00 $35.00 $35.00 $70.00 $13.00 * $20.00 * * $13.00 $21.00 $34.00 $60.00 $50.00 $24.00 $57.00 $47.00 $31.00 $19.00 $25.00 $29.00 $155.00 $179.00 $55.00 $66.00 $90.00 $63.00 $75.00 $90.00 $107.00 $78.00 $90.00 $110.00 $145.00 $94.00 $110.00 $74.00 $94.00 $125.00 $474.00 $706.00 $632.00 * $49.00 $50.00 $168.00 $194.00 $503.00 $34.00 $25.00 $70.00 $378.00 $474.00 $616.00 $355.00 $315.00 * * $99.00 $82.00 $855.00 $873.00 $928.00 $975.00 $375.00 $380.00 $900.00 $45.00 $45.00 $80.00 $74.00 $155.00 $73.00 $95.00 $550.00 $595.00 $575.00 $376.00 $600.00 $624.00 $77.00 $125.00 $76.00 $144.00 $176.00 $214.00 $249.00 $155.00 $150.00 $74.00 $56.00 $185.00 $58.00 $236.00 $46.00 $25.00 $25.00 |
#5 $8,200.00 $3,800.00 * $1,250.00 * * * * * * $6,300.00 $7,500.00 $3,750.00 $500.00 $250.00 $250.00 $28,800.00 $3,300.00 $3,300.00 $400.00 $1,400.00 $900.00 $300.00 $500.00 $1,200.00 $150.00 $7,000.00 $8,500.00 $2,200.00 $1,300.00 $11,700.00 $5,000.00 $4,000.00 $3,000.00 * * $10,000.00 $4,000.00 $3,000.00 $500.00 $1,125.00 $12,750.00 * $1,400.00 $450.00 $6,400.00 $500.00 $3,225.00 $700.00 $1,800.00 $375.00 $1,500.00 $3,000.00 $5,000.00 $400.00 $200.00 * * $300.00 $300.00 $3,750.00 $1,500.00 $625.00 $250.00 $300.00 $300.00 $5,000.00 $200.00 $200.00 $250.00 $600.00 $300.00 $600.00 $850.00 $400.00 $13,125.00 $1,200.00 $1,500.00 $300.00 $3,900.00 $500.00 $100.00 $7,500.00 $10,000.00 $1,750.00 $4,000.00 $5,500.00 $600.00 $400.00 $300.00 $4,000.00 $4,125.00 $1,125.00 $3,600.00 $900.00 $100.00 $900.00 |
TOTAL YEARLY INCREASE TO THE SUPPLEMENTAL BENEFIT FUND = $252,255.00
* THESE ARE EITHER NEW ADA#'S
OR THERE IS NO DATA FOR THIS PROCEDURE
** SEE INTRODUCTORY LETTER FOR FURTHER EXPLANATION
AUDITED SBF REIMBURSEMENTS TO TEACHERS
FOR THE FISCAL YEAR ENDED AUGUST 2000.
DENTAL $1,425,522.00
OPTICAL $213,774.00
Rx CO PAY $79,656.00