|
Zip Code 11234 |
ADA
Code |
Procedure |
**Usual
Fee |
Member
(Reduced)
Fee |
Savings
% |
|
0120 |
Periodic
oral evaluation |
$43 |
$19 |
56% |
|
0150 |
Comprehensive oral evaluation |
$73 |
$32 |
56% |
|
0210 |
Intraoral-complete
series (including bitewings) |
$123 |
$55 |
55% |
|
0330 |
Panoramic
film |
$106 |
$47 |
56% |
|
1110 |
Prophylaxis-adult |
$84 |
$37 |
56% |
|
1120 |
Prophylaxis-child |
$61 |
$28 |
54% |
|
2140 |
Amalgam-one surface, permanent |
$114 |
$46 |
60% |
|
2150 |
Amalgam-two surfaces, permanent |
$143 |
$61 |
57% |
|
2160 |
Amalgam-three surfaces, permanent |
$175 |
$73 |
58% |
|
2330 |
Resin-based composite-one surface, anterior |
$137 |
$57 |
58% |
|
2331 |
Resin-based composite-two surfaces, anterior |
$173 |
$72 |
58% |
|
2332 |
Resin-based composite-three surfaces, anterior |
$212 |
$93 |
56% |
|
2750 |
Crown-porcelain fused to high noble metal |
$1048 |
$491 |
53% |
|
2952 |
Cast post
and core in addition to crown |
$402 |
$175 |
57% |
|
3330 |
Root canal
therapy, molar (excluding final restoration) |
$947 |
$423 |
55% |
|
4341 |
Periodontal scaling and root planing, per quadrant |
$240 |
$98 |
59% |
|
4910 |
Periodontal maintenance procedures (following active therapy) |
$130 |
$57 |
56% |
|
5110 |
Complete
denture-maxillary |
$1421 |
$632 |
55% |
|
7110 |
Single
tooth |
$135 |
$59 |
56% |
|
7210 |
Surgical
removal of erupted tooth |
$256 |
$110 |
57% |
|
*** |
Comprehensive Ortho Treatment of the Adult Dentition This is
for a 24-month program based on CAREINGTON fees for ADA
codes 8090 & 8660 |
$5563 |
$2958 |
47% |
