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Fee Schedule

Know your treatment costs ahead-of-time, or verify charges for treatment, by using this list of approved procedures. The 99,000 dentists in the Careington network have agreed by contract to charge members these published fees (and listed discounts for specialist care).
DIAGNOSTIC (Exams, X-Rays)
ADA code Procedure Average Price You Pay Savings
120 Periodic Oral Evaluation – Established Patient $57 $15 73% off
140 Limited Oral Evaluation – Problem Focused $84 $19 77% off
150 Comprehensive Oral Evaluation – New or Established Patient $98 $19 80% off
210 Intraoral – Complete Series of Radiographic Images $149 $43 71% off
220 Intraoral – Periapical – First Radiographic Image $34 $11 67% off
230 Intraoral – Periapical – Each Additional Radiographic Image $29 $6 79% off
270 Bitewing – Single Radiographic Image $34 $11 67% off
272 Bitewings – Two Radiographic Images $52 $14 73% off
273 Bitewings – Three Radiographic Images $62 $18 70% off
274 Bitewings – Four Radiographic Images $74 $22 70% off
330 Panoramic Radiographic Image $126 $43 65% off
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PREVENTIVE (Cleanings, etc.)
ADA code Procedure Average Price You Pay Savings
1110 Prophylaxis – Adult Cleaning $103 $31 69% off
1120 Prophylaxis – Child Cleaning $80 $23 71% off
1351 Sealant – Per Tooth $67 $22 67% off
1510 Space Maintainer – Fixed – Unilateral $346 $94 72% off
1515 Space Maintainer – Fixed – Bilateral $458 $137 70% off
1520 Space Maintainer – Removable – Unilateral $420 $122 70% off
1525 Space Maintainer – Removable – Bilateral $532 $154 71% off
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RESTORATIVE (Fillings)
ADA code Procedure Average Price You Pay Savings
2140 Amalgam – One Surface, Primary or Permanent $166 $43 74% off
2150 Amalgam – Two Surfaces, Primary or Permanent $210 $55 73% off
2160 Amalgam – Three Surfaces, Primary or Permanent $256 $65 74% off
2161 Amalgam – Four or More Surfaces, Primary or Permanent $301 $79 73% off
2330 Resin – Based Composite – One Surface, Anterior $189 $55 70% off
2331 Resin – Based Composite – Two Surfaces, Anterior $229 $66 71% off
2332 Resin – Based Composite – Three Surfaces, Anterior $282 $83 70% off
2335 Resin – Based Composite – Four or More Surfaces, Anterior $352 $106 69% off
2391 Resin – Based Composite – One Surface, Posterior $204 $69 66% off
2392 Resin – Based Composite – Two Surfaces, Posterior $259 $102 60% off
2393 Resin – Based Composite – Three Surfaces, Posterior $319 $129 59% off
2394 Resin – Based Composite – Four or More Surfaces, Posterior $381 $149 60% off
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RESTORATIVE (Crowns)
ADA code Procedure Average Price You Pay Savings
2710 Crown – Resin-Based Composite (indirect) $1,080 $206 80% off
2720 Crown- Resin With High Noble Metal $1,185 $435 63% off
2750 Crown – Porcelain Fused to High Noble Metal $1,261 $511 59% off
2751 Crown – Porcelain Fused to Predominantly Base Metal $1,181 $462 60% off
2752 Crown – Porcelain Fused to Noble Metal $1,213 $483 60% off
2790 Crown – Full Cast High Noble Metal $1,299 $502 61% off
2791 Crown – Full Cast Predominantly Base Metal $1,139 $450 60% off
2930 Prefabricated Stainless Steel Crown – Primary Tooth $298 $100 66% off
2931 Prefabricated Stainless Steel Crown – Permanent Tooth $344 $114 66% off
2950 Core Buildup – Including Any Pins $296 $100 66% off
2951 Pin Retention Per Tooth in Addition to Restoration $87 $25 71% off
2952 Post and Core in Addition to Crown, Indirectly Fabricated $456 $158 65% off
2954 Prefabricated Post and Core in Addition to Crown $371 $123 66% off
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ENDODONTICS (Root Canals, etc.)
ADA code Procedure Average Price You Pay Savings
3110 Pulp Cap Direct (excluding final restoration) $94 $23 75% off
3120 Pulp Cap Indirect (excluding final restoration) $94 $23 75% off
3220 Therapeutic Pulpotomy (excluding final restoration) $232 $55 76% off
3310 Endodontic Therapy – Anterior Tooth (excluding final restoration) $848 $294 65% off
3320 Endodontic Therapy – Bicuspid Tooth (excluding final restoration) $956 $348 63% off
3330 Endodontic Therapy – Molar (excluding final restoration) $1,167 $438 62% off
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PERIODONTICS (Scaling / Deep Cleaning / Root Planing, etc.)
ADA code Procedure Average Price You Pay Savings
4210 Gingivectomy or Gingivoplasty – Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant $704 $293 58% off
4341 Periodontal Scaling and Root Planing – Four or More Teeth Per Quadrant $284 $102 64% off
4910 Periodontal Maintenance $153 $65 57% off
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PROSTHODONTICS (Dentures – Removable, Partials, etc.)
ADA code Procedure Average Price You Pay Savings
5110 Complete Denture – Maxillary $1,949 $643 67% off
5120 Complete Denture – Mandibular $1,987 $643 67% off
5130 Immediate Denture – Maxillary $2,078 $669 67% off
5140 Immediate Denture – Mandibular $2,089 $669 67% off
5211 Maxillary Partial Denture – Resin Base (including any conventional clasps, rests and teeth) $1,572 $630 59% off
5212 Mandibular Partial Denture – Resin Base (including any conventional clasps, rests and teeth) $1,559 $630 59% off
5213 Maxillary Partial Denture – Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth) $2,029 $729 64% off
5214 Mandibular Partial Denture – Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth) $2,035 $729 64% off
5410 Adjust Complete Denture – Maxillary $103 $37 64% off
5411 Adjust Complete Denture – Mandibular $102 $37 63% off
5510 Repair Broken Complete Denture Base $248 $57 77% off
5520 Replace Missing or Broken Teeth – Complete Denture (each tooth) $217 $55 74% off
5630 Repair or Replace Broken Clasp $304 $66 78% off
5650 Add Tooth to Existing Partial Denture $260 $57 78% off
5660 Add Clasp to Existing Partial Denture $306 $73 76% off
5730 Reline Complete Maxillary Denture (chairside) $426 $136 68% off
5731 Reline Complete Mandibular Denture (chairside) $426 $136 68% off
5740 Reline Maxillary Partial Denture (chairside) $416 $130 68% off
5741 Reline Mandibular Partial Dent (chairside) $422 $130 69% off
5750 Reline Complete Maxillary Denture (lab) $520 $178 65% off
5751 Reline Complete Mandibular Denture (lab) $534 $178 66% off
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PROSTHODONTICS – FIXED (Bridges, Dentures, etc.)
ADA code Procedure Average Price You Pay Savings
6040 Surgical Placement: Eposteal Implant $8,200 20% Discount $1640 off
6050 Surgical Placement: Transosteal Implant $6,024 20% Discount $1204 off
6065 Implant Supported Porcelain/Ceramic Crown $1,692 20% Discount $338 off
6066 Implant Supported Porcelain Fused To Metal Crown (Titanium, Titanium Alloy, High Noble Metal) $1,653 20% Discount $330 off
6067 Implant Supported Metal Crown (Titanium, Titanium Alloy, High Noble Metal) $1,748 20% Discount $349 off
6240 Pontic – Porcelain Fused to High Noble Metal $1,254 $444 64% off
6241 Pontic – Porcelain Fused to Predominantly Base Metal $1,181 $409 65% off
6242 Pontic – Porcelain Fused to Noble Metal $1,193 $427 64% off
6750 Crown – Porcelain Fused to High Noble Metal $1,274 $489 61% off
6751 Crown – Porcelain Fused to Predominantly Base Metal $1,182 $441 62% off
6752 Crown – Porcelain Fused to Noble Metal $1,208 $458 62% off
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ORAL SURGERY (Tooth Extractions, etc.)
ADA code Procedure Average Price You Pay Savings
7140 Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal) $208 $55 73% off
7210 Surgical Removal of Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated $315 $140 55% off
7220 Removal of Impacted Tooth – Soft Tissue $354 $112 68% off
7230 Removal of Impacted Tooth – Partially Bony $444 $147 66% off
7240 Removal of Impacted Tooth – Completely Bony $547 $212 61% off
7250 Surgical Removal of Residual Tooth Roots (cutting procedure) $345 $112 67% off
7310 Alveoloplasty in Conjunction with Extraction – Four or More Teeth or Tooth Spaces, Per Quadrant $341 $94 72% off
7320 Alveoloplasty not in Conjunction with Extractions – Four or More Teeth or Tooth Spaces, Per Quadrant $515 $135 73% off
7510 Incision and Drainage of Abscess – Intraoral Soft Tissue $274 $69 74% off
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ORTHODONTICS (Braces – Children and Adults, etc.)
ADA code Procedure Average Price You Pay Savings
8070 Comprehensive Orthodontic Treatment of the Transitional Dentition $5,517 20% Discount $1103 off
8080 Comprehensive Orthodontic Treatment of the Adolescent Dentition $5,652 20% Discount $1130 off
8090 Comprehensive Orthodontic Treatment of the Adult Dentition $5,667 20% Discount $1133 off
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ADJUNCTIVE SERVICES (Anesthesia, Analgesia, etc.)
ADA code Procedure Average Price You Pay Savings
9110 Palliative (emergency) Treatment Dental Pain – Minor Procedure $148 $37 75% off
9215 Local Anesthesia in Conjunction With Operative or Surgical Procedures $73 $13 82% off
9230 Inhalation of Nitrous Oxide/Anxiolysis, Analgesia $93 $26 72% off
9951 Occlusal Adjustment Limited $214 $51 76% off
9952 Occlusal Adjustment Complete $749 $203 72% off
DISCLAIMERS
* Average Prices based on the 80th percentile of the National Dental Advisory Service Comprehensive Fee Report for 2017
General Information
 
This schedule applies to services provided by a participating Careington General Dentist. The purpose of this schedule is to establish the maximum fee that a General Dentist will charge for each procedure. Member is responsible for all charges at the time of service. Fee schedules are subject to change without prior notification to members.
Dental procedure codes not listed on this schedule will be discounted at 20% off the General Dentist’s normal fee at the time of service.
Participating Specialists (Board Certified or Advanced Degree) do not charge according to a fee schedule. Participating Specialists will give a 20% discount off of their normal fees.
Discount plans are not insurance.
Fee schedules are determined by the zip code of the participating provider.
 
Lab Fees
 
Any procedure involving lab and OSHA fees will incur additional costs. All applicable lab and OSHA fees are the full responsibility of the member and are subject to no discount.
 
Providers
 
While all participating Careington providers are professionally licensed in the state in which they practice, Careington does not guarantee the quality of service of the providers. Any quality of care concerns involving any participating Careington provider should be directed in writing to: Careington Corporation, Attn. Provider Relations, PO Box 2568, Frisco, Texas 75034. Please call 800-290-0523 if you have any further questions.
It is the Member’s responsibility to verify that the dentist is a participating Provider before seeking any treatment. Any dental procedures performed by a non-participating dentist are not discounted and are charged at the dentist’s normal fees.
Careington cannot guarantee the continued participation of any dentist. If the dentist leaves the plan, you will need to select another participating Careington provider. Not all types of dentists may be available in your area.
 
Exclusions and Limitations
 
If the General Dentist’s normal fee for any dental procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that dental procedure.
Careington or its vendors may periodically adjust this fee schedule with 30 days notice to Client.
The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment – many treatments may require more than one dental procedure. Please consult your Careington provider for a detailed treatment plan prior to beginning any work.
 

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      "I am very pleased with LifePerks.  I have saved well over $3,000 using the Dental plan just for myself alone.  My family has also benefited from the Vision plan.  I would highly recommend this plan for anyone interested in quality dental and vision care who wants to save $.    LifePerks, Thanks for being there!"    K. H.  Burnet, Texas

About LifePerks Benefits Network

Savings plans are NOT insurance and the savings will vary by provider, plan and zip code. These plans are not considered to be qualified health plans under the Affordable Care Act. Please consult with the respective plan detail page for additional plan terms. The discounts are available through participating healthcare providers only. To check that your provider participates, refer to your Member's Packet that was issued to you upon enrollment or visit our website or call us. Since there is no paperwork or reimbursement, you must pay for the service at the time it’s provided. You will receive the discount off the provider’s usual and customary fees when you pay. We encourage you to check with your participating provider prior to beginning treatment. Note – not all plans and offers available in all markets. *The vision plan only is administered by Access One Consumer Health, your Discount Medical Plan Organization, 84 Villa Rd. Greenville, SC 29615 - www.accessonedmpo.com. Copyright © 2012 LifePerks for Health. All rights reserved

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