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Dental Plans Fee Schedule-Example Of Dental Fee Discounts From Nationwide Dental Network Using The Red Dental Plan Fee Schedule.
ADA Code |
Sample
General Dentist Procedures
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Dental Office Fees Up To* |
Dental Plan
Fees |
Dental Plan Savings Up To |
00120 |
Periodic Oral Exam |
$60 |
$12 |
80% |
00150 |
Initial Oral Exam |
$103 |
$30 |
71% |
00210 |
X-Ray: Intraoral Complete Series |
$143 |
$50 |
65% |
00330 |
X-Ray: Panoramic |
$117 |
$50 |
57% |
01110 |
Regular Teeth Cleaning (Light Scaling & Polishing) |
$103 |
$38 |
63% |
02140 |
Amalgam Filling (Silver Colored) 1 Surface (Anterior) |
$152 |
$45 |
70% |
02150 |
Amalgam Filling (Silver Colored) 2 Surface (Anterior) |
$199 |
$65 |
67% |
02330 |
Resin Based composite - 1 Surface, Anterior |
$176 |
$60 |
66% |
02331 |
Resin Based Composite - 2 Surface Anterior |
$218 |
$85 |
61% |
02750 |
Porcelain Crown with High Noble Metal |
$1,192 |
$525 |
56% |
03310 |
Root Canal Anterior |
$788 |
$350 |
56% |
03320 |
Root Canal Bicuspid |
$901 |
$375 |
58% |
04355 |
Deep Teeth Cleaning (Full Mouth Debridement / Removal of heavy tartar buildup) |
$216 |
$90 |
58% |
08080 |
Orthodontic Braces by General dentist - children under age 19 |
$4,500 |
$2,000 |
56% |
08090 |
Orthodontic Braces by General dentist - adult 19 and over |
$5,000 |
$2,200 |
56% |
*Current Dental Terminology® 2006
American Dental Association, All Rights Reserved.
*National Dental Advisory Service 2006
Invisalign Braces may not be included.
This fee comparison is an example of the savings.
Fees will vary by region. |
Specialist Fee Schedule
Any Dental Plans member receiving treatment from a participating specialist provider (advanced degree), shall receive a 25% discount off the participating specialist's usual and customary fee for that procedure. These participating specialists include the following:
Orthodontists |
Periodontists |
Endodontists |
Prosthodontists |
Pedodontists |
Oral Surgeons |
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Since some states use more than one dental plan discount fee schedule and fees will vary by region, you can locate dental plan dentists and view the discount fee schedule used by that particular dentist:
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Find Dental Plan Providers In Your Area
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Dental Plans - $ 19.95 per month
Entire Household
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Vision Care, Prescription Drugs, and Chiropractic Benefits Included With the Dental Plans At No Additional Charge.
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