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DENTAL FEE SCHEDULE. Diagnostics. Code. This is a sample list of common preventive and comprehensive dental services, and the current allowed amount per service.GENERAL DENTIST FEE SCHEDULE. Dentists must establish their own fees based on their individual practice and market considerations. Dentist Procedures and Fee Schedule. Use this form to verify fee information for immigration forms. Forms and Document Downloads. After you complete a service, you file claims through the ProviderOne portal. Fee schedules are lists of the maximum allowable amount per unit for the associated HCPCS codes. TitleFile TypeSize (KB)Release DateDurable Medical Equipment Fee Schedule ‑ ExcelXLSX100.