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EXHIBIT I <br /> <br /> TABLE OF ALLOWANCES FOR ORTHODONTICS <br /> (To be used for cases submitted by non-participating* dentists) <br /> <br /> PROCEDURES <br /> <br />Orthodontic Treatment <br /> <br /> Permanent Dentition <br /> <br /> 850 Class I 700.00 <br /> 855 Class II 700.00 <br /> 860 Class III 700,00 <br /> <br /> Mixed De~tition <br /> 870 Class I 400.00 <br /> 871 Class II 400.00 <br /> 872 Class III 400.00 <br /> <br /> Primary Dentition <br /> <br /> 875 Class I 200°00 <br /> 876 Class I I 200.00 <br /> 877 Class III 200.00 <br /> <br /> Appliances for Tooth Guidance <br /> 840 Removable 40.00 <br /> 843 Fixed or cemented 50.00 <br /> <br /> Appliances to Control Harmful Habits <br /> <br /> 84,5 Removable 40.00 <br /> 847 Fixed or cemented 50.00 <br /> <br /> *Non-participating Dentist - Dentist who does not agree to abide by the conditions governing dentist participation in <br /> California Dental Service group dental care program. <br /> <br /> <br />