Call Us At 1 (800) 643-6108|
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 POS network have agreed by contract to charge members these published fees (and listed discounts for specialist care).
|
| DIAGNOSTIC (Exams, X-Rays) | ||||
|---|---|---|---|---|
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 0120 | periodic oral evaluation – established patient | $51 | $23 | 54% off |
| 0140 | limited oral evaluation – problem focused | $76 | $38 | 50% off |
| 0150 | comprehensive oral evaluation – new or established patient | $90 | $39 | 56% off |
| 0160 | detailed and extensive oral evaluation – problem focused, by report | $158 | $102 | 35% off |
| 0170 | re-evaluation – limited, problem focused (established patient; not post-operative visit) | $73 | $28 | 61% off |
| 0180 | comprehensive periodontal evaluation – new or established patient | $95 | $30 | 68% off |
| 0210 | intraoral – complete series (including bitewings) | $131 | $68 | 48% off |
| 0220 | intraoral – periapical first film | $29 | $13 | 55% off |
| 0230 | intraoral – periapical each additional film | $25 | $11 | 56% off |
| 0240 | intraoral – occlusal film | $43 | $18 | 58% off |
| 0250 | extraoral – first film | $67 | $25 | 62% off |
| 0260 | extraoral – each additional film | $57 | $25 | 56% off |
| 0270 | bitewing – single film | $29 | $14 | 51% off |
| 0272 | bitewings – two films | $45 | $21 | 53% off |
| 0273 | bitewings – three films | $57 | $24 | 57% off |
| 0274 | bitewings – four films | $66 | $29 | 56% off |
| 0277 | vertical bitewings – 7 to 8 films | $101 | $38 | 62% off |
| 0330 | panoramic film | $110 | $55 | 50% off |
| 0340 | cephalometric film | $122 | $68 | 44% off |
| 0350 | oral/facial photographic images | $74 | $31 | 58% off |
| 0460 | pulp vitality tests | $57 | $27 | 52% off |
| 0470 | diagnostic casts | $115 | $56 | 51% off |
| PREVENTIVE (Cleanings, etc.) | ||||
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 1110 | prophylaxis – adult | $91 | $46 | 49% off |
| 1120 | prophylaxis – child | $67 | $33 | 50% off |
| 1203 | topical application of fluoride – child | $38 | $18 | 52% off |
| 1204 | topical application of fluoride – adult | $38 | $20 | 47% off |
| 1330 | oral hygiene instructions | $57 | $33 | 42% off |
| 1351 | sealant – per tooth | $56 | $25 | 55% off |
| 1510 | space maintainer – fixed – unilateral | $317 | $161 | 49% off |
| 1515 | space maintainer – fixed – bilateral | $428 | $213 | 50% off |
| 1520 | space maintainer – removable – unilateral | $388 | $200 | 48% off |
| 1525 | space maintainer – removable – bilateral | $488 | $273 | 44% off |
| 1550 | re-cementation of space maintainer | $88 | $35 | 60% off |
| 1555 | removal of fixed space maintainer | $79 | 20% Discount | $15 off |
| RESTORATIVE (Fillings) | ||||
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 2140 | amalgam – one surface, primary or permanent | $141 | $60 | 57% off |
| 2150 | amalgam – two surfaces, primary or permanent | $179 | $77 | 56% off |
| 2160 | amalgam – three surfaces, primary or permanent | $222 | $93 | 58% off |
| 2161 | amalgam – four or more surfaces, primary or permanent | $259 | $113 | 56% off |
| 2330 | resin-based composite – one surface, anterior | $164 | $71 | 56% off |
| 2331 | resin-based composite – two surfaces, anterior | $202 | $89 | 55% off |
| 2332 | resin-based composite – three surfaces, anterior | $253 | $109 | 56% off |
| 2335 | resin-based composite – four or more surfaces or involving incisal angle (anterior) | $313 | $129 | 58% off |
| 2390 | resin-based composite crown, anterior | $457 | $182 | 60% off |
| 2391 | resin-based composite – one surface, posterior | $181 | $78 | 56% off |
| 2392 | resin-based composite – two surfaces, posterior | $235 | $109 | 53% off |
| 2393 | resin-based composite – three surfaces, posterior | $291 | $135 | 53% off |
| 2394 | resin-based composite – four or more surfaces, posterior | $346 | $140 | 59% off |
| RESTORATIVE (Crowns) | ||||
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 2510 | inlay – metallic – one surface | $861 | $330 | 61% off |
| 2520 | inlay – metallic – two surfaces | $889 | $374 | 57% off |
| 2530 | inlay – metallic – three or more surfaces | $960 | $431 | 55% off |
| 2542 | onlay – metallic-two surfaces | $1006 | $394 | 60% off |
| 2543 | onlay – metallic-three surfaces | $1014 | $442 | 56% off |
| 2544 | onlay – metallic-four or more surfaces | $1041 | $461 | 55% off |
| 2610 | inlay – porcelain/ceramic – one surface | $922 | $388 | 57% off |
| 2620 | inlay – porcelain/ceramic – two surfaces | $955 | $409 | 57% off |
| 2630 | inlay – porcelain/ceramic – three or more surfaces | $1013 | $436 | 56% off |
| 2642 | onlay – porcelain/ceramic – two surfaces | $1017 | $424 | 58% off |
| 2643 | onlay – porcelain/ceramic – three surfaces | $1049 | $457 | 56% off |
| 2644 | onlay – porcelain/ceramic – four or more surfaces | $1087 | $486 | 55% off |
| 2650 | inlay – resin-based composite – one surface | $879 | $255 | 70% off |
| 2651 | inlay – resin-based composite – two surfaces | $896 | $304 | 66% off |
| 2652 | inlay – resin-based composite – three or more surfaces | $933 | $319 | 65% off |
| 2662 | onlay – resin-based composite – two surfaces | $953 | $404 | 57% off |
| 2663 | onlay – resin-based composite – three surfaces | $990 | $412 | 58% off |
| 2664 | onlay – resin-based composite – four or more surfaces | $1022 | $432 | 57% off |
| 2710 | crown – resin-based composite (indirect) | $968 | $204 | 78% off |
| 2720 | crown – resin with high noble metal | $1063 | $563 | 47% off |
| 2721 | crown – resin with predominantly base metal | $1014 | $526 | 48% off |
| 2722 | crown – resin with noble metal | $1031 | $538 | 47% off |
| 2740 | crown – porcelain/ceramic substrate | $1151 | $575 | 50% off |
| 2750 | crown – porcelain fused to high noble metal | $1119 | $568 | 49% off |
| 2751 | crown – porcelain fused to predominantly base metal | $1031 | $529 | 48% off |
| 2752 | crown – porcelain fused to noble metal | $1055 | $542 | 48% off |
| 2780 | crown – 3/4 cast high noble metal | $1064 | $556 | 47% off |
| 2781 | crown – 3/4 cast predominantly base metal | $1031 | $535 | 48% off |
| 2782 | crown – 3/4 cast noble metal | $1039 | $554 | 46% off |
| 2783 | crown – 3/4 porcelain/ceramic | $1094 | $590 | 46% off |
| 2790 | crown – full cast high noble metal | $1125 | $547 | 51% off |
| 2791 | crown – full cast predominantly base metal | $995 | $522 | 47% off |
| 2792 | crown – full cast noble metal | $1031 | $530 | 48% off |
| 2910 | recement inlay, onlay, or partial coverage restoration | $112 | $48 | 57% off |
| 2920 | recement crown | $112 | $49 | 56% off |
| 2930 | prefabricated stainless steel crown – primary tooth | $268 | $134 | 50% off |
| 2931 | prefabricated stainless steel crown – permanent tooth | $326 | $151 | 53% off |
| 2932 | prefabricated resin crown | $352 | $164 | 53% off |
| 2933 | prefabricated stainless steel crown with resin window | $367 | $185 | 49% off |
| 2940 | protective restoration | $123 | $51 | 58% off |
| 2950 | core buildup, including any pins | $268 | $128 | 52% off |
| 2951 | pin retention – per tooth, in addition to restoration | $75 | $27 | 64% off |
| 2952 | post and core in addition to crown, indirectly fabricated | $418 | $194 | 53% off |
| 2953 | each additional indirectly fabricated post – same tooth | $325 | $124 | 61% off |
| 2954 | prefabricated post and core in addition to crown | $334 | $161 | 51% off |
| 2955 | post removal (not in conjunction with endodontic therapy) | $296 | $122 | 58% off |
| 2957 | each additional prefabricated post – same tooth | $209 | $59 | 71% off |
| 2960 | labial veneer (resin laminate) – chairside | $669 | $395 | 40% off |
| ENDODONTICS (Root Canals, etc.) | ||||
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 3110 | pulp cap – direct (excluding final restoration) | $83 | $35 | 57% off |
| 3120 | pulp cap – indirect (excluding final restoration) | $85 | $27 | 68% off |
| 3220 | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament | $198 | $83 | 58% off |
| 3221 | pulpal debridement, primary and permanent teeth | $235 | $81 | 65% off |
| 3230 | pulpal therapy (resorbable filling) – anterior, primary tooth (excluding final restoration) | $282 | $87 | 69% off |
| 3240 | pulpal therapy (resorbable filling) – posterior, primary tooth (excluding final restoration) | $319 | $94 | 70% off |
| 3310 | endodontic therapy, anterior tooth (excluding final restoration) | $726 | $349 | 51% off |
| 3320 | endodontic therapy, bicuspid tooth (excluding final restoration) | $837 | $426 | 49% off |
| 3330 | endodontic therapy, molar (excluding final restoration) | $1014 | $550 | 45% off |
| 3331 | treatment of root canal obstruction; non-surgical access | $630 | $213 | 66% off |
| 3332 | incomplete endodontic therapy; inoperable, unrestorable or fractured tooth | $449 | $192 | 57% off |
| 3333 | internal root repair of perforation defects | $356 | $94 | 73% off |
| 3346 | retreatment of previous root canal therapy – anterior | $862 | $469 | 45% off |
| 3347 | retreatment of previous root canal therapy – bicuspid | $971 | $553 | 43% off |
| 3348 | retreatment of previous root canal therapy – molar | $1163 | $666 | 42% off |
| 3351 | apexification/recalcification/pulpal regeneration – initial visit (apical closure/calcific repair of perforations, root resorption, pulp space disinfection, etc.) | $365 | $199 | 45% off |
| 3352 | apexification/recalcification/pulpal regeneration – interim medication replacement (apical closure/calcific repair of perforations, root resorption, pulp space disinfection, etc.) | $267 | $86 | 67% off |
| 3353 | apexification/recalcification – final visit (includes completed root canal therapy – apical closure/calcific repair of perforations, root resorption, etc.) | $552 | $291 | 47% off |
| 3410 | apicoectomy/periradicular surgery – anterior | $703 | $399 | 43% off |
| 3421 | apicoectomy/periradicular surgery – bicuspid (first root) | $782 | $437 | 44% off |
| 3425 | apicoectomy/periradicular surgery – molar (first root) | $891 | $493 | 44% off |
| 3426 | apicoectomy/periradicular surgery (each additional root) | $428 | $164 | 61% off |
| 3430 | retrograde filling – per root | $282 | $122 | 56% off |
| 3450 | root amputation – per root | $495 | $244 | 50% off |
| 3470 | intentional reimplantation (including necessary splinting) | $809 | $489 | 39% off |
| 3910 | surgical procedure for isolation of tooth with rubber dam | $241 | $63 | 73% off |
| 3920 | hemisection (including any root removal), not including root canal therapy | $469 | $191 | 59% off |
| 3950 | canal preparation and fitting of preformed dowel or post | $270 | $87 | 67% off |
| PERIODONTICS (Scaling / Deep Cleaning / Root Planing, etc.) | ||||
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 4210 | gingivectomy or gingivoplasty – four or more contiguous teeth or tooth bounded spaces per quadrant | $633 | $341 | 46% off |
| 4211 | gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant | $312 | $113 | 63% off |
| 4230 | anatomical crown exposure – four or more contiguous teeth per quadrant | $750 | 20% Discount | $150 off |
| 4231 | anatomical crown exposure – one to three teeth per quadrant | $600 | 20% Discount | $120 off |
| 4240 | gingival flap procedure, including root planing – four or more contiguous teeth or tooth bounded spaces per quadrant | $750 | $401 | 46% off |
| 4241 | gingival flap procedure, including root planing – one to three contiguous teeth or tooth bounded spaces per quadrant | $633 | $289 | 54% off |
| 4245 | apically positioned flap | $828 | $363 | 56% off |
| 4249 | clinical crown lengthening – hard tissue | $777 | $458 | 41% off |
| 4260 | osseous surgery (including flap entry and closure) – four or more contiguous teeth or tooth bounded spaces per quadrant | $1121 | $647 | 42% off |
| 4261 | osseous surgery (including flap entry and closure) – one to three contiguous teeth or tooth bounded spaces per quadrant | $895 | $370 | 58% off |
| 4263 | bone replacement graft – first site in quadrant | $719 | $197 | 72% off |
| 4264 | bone replacement graft – each additional site in quadrant | $572 | $132 | 76% off |
| 4266 | guided tissue regeneration – resorbable barrier, per site | $843 | $237 | 71% off |
| 4267 | guided tissue regeneration – nonresorbable barrier, per site (includes membrane removal) | $973 | $304 | 68% off |
| 4268 | surgical revision procedure, per tooth | $842 | $367 | 56% off |
| 4270 | pedicle soft tissue graft procedure | $844 | $479 | 43% off |
| 4271 | free soft tissue graft procedure (including donor site surgery) | $923 | $493 | 46% off |
| 4320 | provisional splinting – intracoronal | $511 | $216 | 57% off |
| 4321 | provisional splinting – extracoronal | $469 | $189 | 59% off |
| 4341 | periodontal scaling and root planing – four or more teeth per quadrant | $258 | $116 | 55% off |
| 4342 | periodontal scaling and root planing – one to three teeth per quadrant | $188 | $57 | 69% off |
| 4355 | full mouth debridement to enable comprehensive evaluation and diagnosis | $183 | $78 | 57% off |
| 4910 | periodontal maintenance | $139 | $71 | 48% off |
| 4920 | unscheduled dressing change (by someone other than treating dentist) | $103 | $60 | 41% off |
| PROSTHODONTICS (Dentures – Removable, Partials, etc.) | ||||
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 5110 | complete denture – maxillary | $1711 | $754 | 55% off |
| 5120 | complete denture – mandibular | $1711 | $754 | 55% off |
| 5130 | immediate denture – maxillary | $1828 | $823 | 54% off |
| 5140 | immediate denture – mandibular | $1829 | $823 | 55% off |
| 5211 | maxillary partial denture – resin base (including any conventional clasps, rests and teeth) | $1356 | $740 | 45% off |
| 5212 | mandibular partial denture – resin base (including any conventional clasps, rests and teeth) | $1359 | $740 | 45% off |
| 5213 | maxillary partial denture – cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) | $1779 | $835 | 53% off |
| 5214 | mandibular partial denture – cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) | $1781 | $835 | 53% off |
| 5281 | removable unilateral partial denture – one piece cast metal (including clasps and teeth | $1005 | $486 | 51% off |
| 5410 | adjust complete denture – maxillary | $90 | $41 | 54% off |
| 5411 | adjust complete denture – mandibular | $90 | $41 | 54% off |
| 5421 | adjust partial denture – maxillary | $90 | $41 | 54% off |
| 5422 | adjust partial denture – mandibular | $90 | $41 | 54% off |
| 5510 | repair broken complete denture base | $211 | $82 | 61% off |
| 5520 | replace missing or broken teeth – complete denture (each tooth) | $188 | $68 | 63% off |
| 5610 | repair resin denture base | $204 | $89 | 56% off |
| 5620 | repair cast framework | $286 | $97 | 66% off |
| 5630 | repair or replace broken clasp | $263 | $117 | 55% off |
| 5640 | replace broken teeth – per tooth | $188 | $76 | 59% off |
| 5650 | add tooth to existing partial denture | $223 | $103 | 53% off |
| 5660 | add clasp to existing partial denture | $271 | $124 | 54% off |
| 5710 | rebase complete maxillary denture | $591 | $307 | 48% off |
| 5711 | rebase complete mandibular denture | $586 | $293 | 50% off |
| 5720 | rebase maxillary partial denture | $560 | $290 | 48% off |
| 5721 | rebase mandibular partial denture | $558 | $290 | 48% off |
| 5730 | reline complete maxillary denture (chairside) | $373 | $173 | 53% off |
| 5731 | reline complete mandibular denture (chairside) | $371 | $173 | 53% off |
| 5740 | reline maxillary partial denture (chairside) | $366 | $158 | 56% off |
| 5741 | reline mandibular partial denture (chairside) | $371 | $158 | 57% off |
| 5750 | reline complete maxillary denture (laboratory) | $477 | $231 | 51% off |
| 5751 | reline complete mandibular denture (laboratory) | $477 | $231 | 51% off |
| 5760 | reline maxillary partial denture (laboratory) | $469 | $227 | 51% off |
| 5761 | reline mandibular partial denture (laboratory) | $469 | $227 | 51% off |
| 5810 | interim complete denture (maxillary) | $877 | $373 | 57% off |
| 5811 | interim complete denture (mandibular) | $876 | $373 | 57% off |
| 5820 | interim partial denture (maxillary) | $703 | $300 | 57% off |
| 5821 | interim partial denture (mandibular) | $703 | $300 | 57% off |
| 5850 | tissue conditioning, maxillary | $210 | $72 | 65% off |
| 5851 | tissue conditioning, mandibular | $209 | $72 | 65% off |
| PROSTHODONTICS – FIXED (Bridges, Dentures, etc.) | ||||
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 6210 | pontic – cast high noble metal | $1087 | $497 | 54% off |
| 6211 | pontic – cast predominantly base metal | $1014 | $465 | 54% off |
| 6212 | pontic – cast noble metal | $1031 | $485 | 52% off |
| 6240 | pontic – porcelain fused to high noble metal | $1116 | $490 | 56% off |
| 6241 | pontic – porcelain fused to predominantly base metal | $1031 | $452 | 56% off |
| 6242 | pontic – porcelain fused to noble metal | $1058 | $477 | 54% off |
| 6245 | pontic – porcelain/ceramic | $1136 | $487 | 57% off |
| 6250 | pontic – resin with high noble metal | $1073 | $485 | 54% off |
| 6251 | pontic – resin with predominantly base metal | $1055 | $447 | 57% off |
| 6252 | pontic – resin with noble metal | $1055 | $461 | 56% off |
| 6545 | retainer – cast metal for resin bonded fixed prosthesis | $854 | $207 | 75% off |
| 6548 | retainer – porcelain/ceramic for resin bonded fixed prosthesis | $947 | $394 | 58% off |
| 6720 | crown – resin with high noble metal | $1057 | $546 | 48% off |
| 6721 | crown – resin with predominantly base metal | $1031 | $519 | 49% off |
| 6722 | crown – resin with noble metal | $1047 | $529 | 49% off |
| 6740 | crown – porcelain/ceramic | $1153 | $494 | 57% off |
| 6750 | crown – porcelain fused to high noble metal | $1120 | $559 | 50% off |
| 6751 | crown – porcelain fused to predominantly base metal | $1014 | $523 | 48% off |
| 6752 | crown – porcelain fused to noble metal | $1048 | $535 | 48% off |
| 6780 | crown – 3/4 cast high noble metal | $1073 | $529 | 50% off |
| 6781 | crown – 3/4 cast predominantly base metal | $1030 | $465 | 54% off |
| 6782 | crown – 3/4 cast noble metal | $1055 | $471 | 55% off |
| 6783 | crown – 3/4 porcelain/ceramic | $1103 | $479 | 56% off |
| 6790 | crown – full cast high noble metal | $1103 | $541 | 50% off |
| 6791 | crown – full cast predominantly base metal | $1014 | $512 | 49% off |
| 6792 | crown – full cast noble metal | $1048 | $531 | 49% off |
| 6930 | recement fixed partial denture | $173 | $65 | 62% off |
| 6970 | post and core in addition to fixed partial denture retainer, indirectly fabricated | $429 | $181 | 57% off |
| 6972 | prefabricated post and core in addition to fixed partial denture retainer | $343 | $147 | 57% off |
| 6973 | core build up for retainer, including any pins | $271 | $119 | 56% off |
| 6975 | coping – metal | $704 | $325 | 53% off |
| 6976 | each additional indirectly fabricated post – same tooth | $302 | $118 | 60% off |
| 6977 | each additional prefabricated post – same tooth | $216 | $71 | 67% off |
| ORAL SURGERY (Tooth Extractions, etc.) | ||||
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 7111 | extraction, coronal remnants – deciduous tooth | $135 | $64 | 52% off |
| 7140 | extraction, erupted tooth or exposed root (elevation and/or forceps removal) | $174 | $77 | 55% off |
| 7210 | surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated | $276 | $135 | 51% off |
| 7220 | removal of impacted tooth – soft tissue | $313 | $153 | 51% off |
| 7230 | removal of impacted tooth – partially bony | $396 | $203 | 48% off |
| 7240 | removal of impacted tooth – completely bony | $483 | $238 | 50% off |
| 7241 | removal of impacted tooth – completely bony, with unusual surgical complications | $577 | $300 | 48% off |
| 7250 | surgical removal of residual tooth roots (cutting procedure) | $313 | $129 | 58% off |
| 7270 | tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth | $563 | $262 | 53% off |
| 7272 | tooth transplantation (includes reimplantation from one site to another and splinting and/or stabilization) | $774 | $298 | 61% off |
| 7280 | surgical access of an unerupted tooth | $474 | $287 | 39% off |
| 7285 | biopsy of oral tissue – hard (bone, tooth) | $457 | $465 | -1% off |
| 7286 | biopsy of oral tissue – soft | $326 | $208 | 36% off |
| 7310 | alveoloplasty in conjunction with extractions – four or more teeth or tooth spaces, per quadrant | $305 | $142 | 53% off |
| 7320 | alveoloplasty not in conjunction with extractions -four or more teeth or tooth spaces, per quadrant | $446 | $353 | 20% off |
| 7450 | removal of benign odontogenic cyst or tumor – lesion diameter up to 1.25 cm | $625 | $414 | 33% off |
| 7451 | removal of benign odontogenic cyst or tumor – lesion diameter greater than 1.25 cm | $822 | $651 | 20% off |
| 7460 | removal of benign nonodontogenic cyst or tumor – lesion diameter up to 1.25 cm | $590 | $414 | 29% off |
| 7461 | removal of benign nonodontogenic cyst or tumor – lesion diameter greater than 1.25 cm | $938 | $651 | 30% off |
| 7510 | incision and drainage of abscess – intraoral soft tissue | $235 | $135 | 42% off |
| 7910 | suture of recent small wounds up to 5 cm | $305 | $190 | 37% off |
| 7911 | complicated suture – up to 5 cm | $502 | $473 | 5% off |
| 7912 | complicated suture – greater than 5 cm | $834 | $675 | 19% off |
| 7951 | sinus augmentation with bone or bone substitutes | $3272 | 20% Discount | $654 off |
| 7960 | frenulectomy – also known as frenectomy or frenotomy – separate procedure not incidental to another procedure | $447 | $239 | 46% off |
| 7970 | excision of hyperplastic tissue – per arch | $516 | $307 | 40% off |
| 7971 | excision of pericoronal gingiva | $266 | $97 | 63% off |
| ORTHODONTICS (Braces – Children and Adults, etc.) | ||||
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 8010 | limited orthodontic treatment of the primary dentition | $2200 | 20% Discount | $440 off |
| 8020 | limited orthodontic treatment of the transitional dentition | $2619 | 20% Discount | $523 off |
| 8030 | limited orthodontic treatment of the adolescent dentition | $3096 | 20% Discount | $619 off |
| 8040 | limited orthodontic treatment of the adult dentition | $3342 | 20% Discount | $668 off |
| 8050 | interceptive orthodontic treatment of the primary dentition | $2628 | 20% Discount | $525 off |
| 8060 | interceptive orthodontic treatment of the transitional dentition | $2770 | 20% Discount | $554 off |
| 8070 | comprehensive orthodontic treatment of the transitional dentition | $5134 | 20% Discount | $1026 off |
| 8080 | comprehensive orthodontic treatment of the adolescent dentition | $5186 | 20% Discount | $1037 off |
| 8090 | comprehensive orthodontic treatment of the adult dentition | $5211 | 20% Discount | $1042 off |
| 8210 | removable appliance therapy | $861 | 20% Discount | $172 off |
| 8660 | pre-orthodontic treatment visit | $407 | 20% Discount | $81 off |
| ADJUNCTIVE SERVICES (Anesthesia, Analgesia, etc.) | ||||
| ADA code | Procedure | Typical Fee | You Pay | Savings |
| 9110 | palliative (emergency) treatment of dental pain – minor procedure | $130 | $49 | 62% off |
| 9120 | fixed partial denture sectioning | $244 | 20% Discount | $48 off |
| 9211 | regional block anesthesia | $95 | $22 | 76% off |
| 9215 | local anesthesia in conjunction with operative or surgical procedures | $66 | $15 | 77% off |
| 9230 | inhalation of nitrous oxide / anxiolysis, analgesia | $80 | $27 | 66% off |
| 9310 | consultation – diagnostic service provided by dentist or physician other than requesting dentist or physician | $134 | $103 | 23% off |
| 9410 | house/extended care facility call | $243 | $136 | 44% off |
| 9420 | hospital or ambulatory surgical center call | $305 | $187 | 38% off |
| 9430 | office visit for observation (during regularly scheduled hours) – no other services performed | $79 | $35 | 55% off |
| 9440 | office visit – after regularly scheduled hours | $180 | $63 | 65% off |
| 9910 | application of desensitizing medicament | $68 | $22 | 67% off |
| 9911 | application of desensitizing resin for cervical and/or root surface, per tooth | $81 | $32 | 60% off |
| 9941 | fabrication of athletic mouthguard | $268 | $77 | 71% off |
| 9950 | occlusion analysis – mounted case | $361 | $136 | 62% off |
| 9951 | occlusal adjustment – limited | $188 | $61 | 67% off |
| 9952 | occlusal adjustment – complete | $700 | $348 | 50% off |
| 9970 | enamel microabrasion | $211 | $47 | 77% off |
| DISCLAIMERS | ||||
| * Typical fees based on the 80th percentile of the National Dental Advisory Service Comprehensive Fee Report for 2012
General Information
Lab Fees
Providers
|
||||
What Our Customers Tell Us!
"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
Join Us On Facebook
Join Us On Twitter
Join Us On In.com
Subscribe to Our Blog