<!--#include file="feeTop.asp"--> <style> body {font-family:Arial, Helvetica, sans-serif;font-size:12px; font-weight:bold;} .head {color:#009900} table tr td {font-size:13px; font-weight:bold;} .red {color: #FF0000} </style> <MAP NAME="MenuMap"> <AREA SHAPE="RECT" COORDS="0,0,57,20" href="index.htm" TARGET="_self"> <AREA SHAPE="RECT" COORDS="59,0,170,20" href="schedule.htm" TARGET="_self"> <AREA SHAPE="RECT" COORDS="172,0,337,20" href="index.htm#dd" TARGET="_self"> <AREA SHAPE="RECT" COORDS="339,0,446,20" href="freekit.htm" TARGET="_self"> <AREA SHAPE="RECT" COORDS="448,0,558,20" href="BrokerForm.htm" TARGET="_self"> <AREA SHAPE="RECT" COORDS="559,0,635,20" href="index.htm#PAY" TARGET ="_self"> </MAP> <table> <tr> <td align="center"><FONT SIZE="+1" FACE="Arial" COLOR="#009900">Southeast General Dentists<BR> Fee Schedule<BR> <FONT FACE="Arial" COLOR="red">As of June 1, 2007<BR> <FONT FACE="Arial" COLOR="#000000" size="2">(all procedures as performed by a general Dentist) <p> <A href="#CP"><IMG alt="Cosmetic Procedures" src="Graphics/cosmetic_new.gif" align=top border=0 ></A> <A href="#P"><IMG alt=Periodontics src="Graphics/periodontics_new.gif" align=top border=0></A><BR> <A href="#DPP"><IMG alt="Diagnostic &amp; Preventative Procedures" src ="Graphics/diagnostic_new.gif" align=top border=0 ></A> <A href="#PF"><IMG alt="Fixed Prosthodontics" src="Graphics/fixedprosthodontics_new.gif" align=top border=0 ></A><BR> <A href="#E"><IMG alt=Endodontics src="Graphics/endodontics_new.gif" align=top border=0></A> <A href="#PR"><IMG alt=Prosthodontics src="Graphics/prosthodontics_new.gif" align=top border=0></A><BR> <A href="#O"><IMG alt="Oral Surgery" src="Graphics/oralsurgery_new.gif" align=top border=0 ></A> <A href="#RP"><IMG alt="Restorative Procedures" src="Graphics/restorativeprocedures_new.gif" align=top border=0 ></A><BR></td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"> <td width="6%"><u>ADA CODE</u></td> <TD WIDTH="59%" ALIGN=left><A NAME="DPP"></A> <U>DIAGNOSTIC &amp; PREVENTATIVE PROCEDURES</U></TD> <TD WIDTH="20%" ALIGN=right><U>NDPA FEE</U></TD> <TD WIDTH="20%" ALIGN=right><U>USUAL FEE</U></TD> </TR> <TR> <td>D0150</td> <TD ALIGN=left >Comprehensive oral evaluation - new or established</TD> <TD ALIGN=right>NO CHARGE*</TD> <TD ALIGN=right>$55.00</TD> </TR> <TR> <td>D0120</td> <TD ALIGN=left >Periodic oral evaluation - established patient</TD> <TD ALIGN=right>NO CHARGE* </TD> <TD ALIGN=right>$55.00</TD> </TR> <TR> <td>D0140</td> <TD ALIGN=left >Consultation (limited oral evaluation - problem focused)</TD> <TD ALIGN=right >$35.00</TD> <TD ALIGN=right >$70.00</TD> </TR> <TR> <td>D0220</td> <TD ALIGN=left >Single x-ray (any type)</TD> <TD ALIGN=right >$10.00</TD> <TD ALIGN=right >$20.00</TD> </TR> <TR> <td>D0210</td> <TD ALIGN=left >X-rays (up to full mouth, or at least 3 films taken)</TD> <TD ALIGN=right >$40.00</TD> <TD ALIGN=right >$100.00</TD> </TR> <TR> <td>D0330</td> <TD ALIGN=left >X-rays - Panoramic film</TD> <TD ALIGN=right >$35.00</TD> <TD ALIGN=right >$95.00</TD> </TR> <TR> <td>D1110</td> <TD ALIGN=left >Adult cleaning, polishing and scaling </TD> <TD ALIGN=right >$40.00</TD> <TD ALIGN=right >$90.00</TD> </TR> <TR> <td>D1120</td> <TD ALIGN=left >Child cleaning and polishing - excluding flouride</TD> <TD ALIGN=right >$30.00</TD> <TD ALIGN=right >$60.00</TD> </TR> <TR> <td>D1203</td> <TD ALIGN=left >Topical fluoride treatment for children </TD> <TD ALIGN=right >$16.00</TD> <TD ALIGN=right >$40.00</TD> </TR> <TR> <td>D9110</td> <TD ALIGN=left >Palliative (emergency) treatment of dental pain</TD> <TD ALIGN=right >$30.00</TD> <TD ALIGN=right >$60.00</TD> </TR> <TR> <td>D1351</td> <TD ALIGN=left >Sealant - per tooth</TD> <TD ALIGN=right >$25.00</TD> <TD ALIGN=right >$45.00</TD> </TR> </TABLE> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> </td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"><td width="6%"><u>ADA CODE</u></td> <TD WIDTH="59%" ALIGN=left><A NAME="RP"></A> <U>RESTORATIVE PROCEDURES (FILLINGS)</U></TD> <TD WIDTH="20%" ALIGN=right><U>NDPA FEE</U></TD> <TD WIDTH="20%" ALIGN=right><U>USUAL FEE</U></TD> </TR> <TR> <td>D2951</td> <TD HEIGHT=30 ALIGN=left >Pin retention - per tooth</TD> <td align="right">$22.00</td> <td align="right">$55.00</td> </TR> <TR> <td>D2940</td> <TD HEIGHT=30 ALIGN=left >Sedative filling</TD> <td align="right">$33.00</td> <td align="right">$65.00</td> </TR> <TR><td></td> <TD HEIGHT=30 ALIGN=left COLSPAN=3><U>Silver Amalgams: <I>Permanent</I></U></TD> </TR> <TR> <td>D2140</td> <TD ALIGN=left>One Surface</TD> <TD ALIGN=right>$55.00</TD> <TD ALIGN=right>$115.00</TD> </TR> <TR> <td>D2150</td> <TD ALIGN=left>Two Surfaces</TD> <TD ALIGN=right>$65.00</TD> <TD ALIGN=right>$145.00</TD> </TR> <TR> <td>D2160</td> <TD ALIGN=left>Three Surfaces</TD> <TD ALIGN=right>$80.00</TD> <TD ALIGN=right>$165.00</TD> </TR> <TR> <td>D2161</td> <TD ALIGN=left>Four Surfaces or more</TD> <TD ALIGN=right>$95.00</TD> <TD ALIGN=right>$200.00</TD> </TR> <TR> <td></td> <TD HEIGHT=30 ALIGN=left COLSPAN=3><u>Composite Resins: Permanent</u></TD> </TR> <TR><td></td> <TD HEIGHT=30 ALIGN=left COLSPAN=3><u><em>Anterior Composites</em></u></TD> </TR> <TR> <td>D2330</td> <TD ALIGN=left>One Surface</TD> <TD ALIGN=right>$54.00</TD> <TD ALIGN=right>$145.00</TD> </TR> <TR> <td>D2331</td> <TD ALIGN=left>Two Surfaces</TD> <TD ALIGN=right>$70.00</TD> <TD ALIGN=right>$165.00</TD> </TR> <TR> <td>D2332</td> <TD ALIGN=left>Three Surfaces</TD> <TD ALIGN=right>$80.00</TD> <TD ALIGN=right>$195.00</TD> </TR> <TR> <td>D2335</td> <TD ALIGN=left>Four Surfaces or more</TD> <TD ALIGN=right>$97.00</TD> <TD ALIGN=right>$210.00</TD> </TR> <TR><td></td> <TD HEIGHT=30 ALIGN=left COLSPAN=3><U><I>Posterior composites:</I></U></TD> </TR> <TR> <td>D2391</td> <TD ALIGN=left>One Surface</TD> <TD ALIGN=right>$65.00</TD> <TD ALIGN=right>$155.00</TD> </TR> <TR> <td>D2392</td> <TD ALIGN=left>Two Surfaces</TD> <TD ALIGN=right>$85.00</TD> <TD ALIGN=right>$185.00</TD> </TR> <TR> <td>D2393</td> <TD ALIGN=left>Three Surfaces</TD> <TD ALIGN=right>$100.00</TD> <TD ALIGN=right>$215.00</TD> </TR> <TR> <td>D2394</td> <TD ALIGN=left>Four Surfaces or more</TD> <TD ALIGN=right>$115.00</TD> <TD ALIGN=right>$230.00</TD> </TR> </TABLE> </LEFT> <CENTER> </CENTER> <HR> </td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"><td width="6%"><u>ADA CODE</u></td> <TD WIDTH="59%" ALIGN=left><A NAME="CP"></A> <U>COSMETIC PROCEDURES</U></TD> <TD WIDTH="20%" ALIGN=right><U>NDPA FEE</U></TD> <TD WIDTH="20%" ALIGN=right><U>USUAL FEE</U></TD> </TR> <TR><td></td> <TD HEIGHT=30 ALIGN=left COLSPAN=3><U>Bonding/Veneers (per tooth)</U></TD> </TR> <TR> <td>D2960</td> <TD ALIGN=left>Labial veneer (resin) - chairside</TD> <TD ALIGN=right>$195.00</TD> <TD ALIGN=right>$375.00</TD> </TR> <TR> <td>D2962</td> <TD ALIGN=left>Labial veneer (porcelain) - laboratory</TD> <TD ALIGN=right>$435.00</TD> <TD ALIGN=right>$815.00</TD> </TR> </TABLE> </LEFT> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> </td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"><td width="6%"><u>ADA CODE</u></td> <TD WIDTH="59%" ALIGN=left><A NAME="E"></A> <U>ENDODONTICS PROCEDURES </U></TD> <TD WIDTH="20%" ALIGN=right><U>NDPA FEE</U></TD> <TD WIDTH="20%" ALIGN=right><U>USUAL FEE</U></TD> </TR> <TR> <td>D3110</td> <TD ALIGN=left>Pulp capping (Excl. final restoration)</TD> <TD ALIGN=right>$35.00</TD> <TD ALIGN=right>$65.00</TD> </TR> <TR> <td>D3220</td> <TD ALIGN=left>Pulpotomy (excl. final restoration) </TD> <TD ALIGN=right>$75.00</TD> <TD ALIGN=right>$115.00</TD> </TR> <TR> <td></td> <TD ALIGN=left colspan="2"><i>Root Canal Therapy </i></TD> </TR> <TR> <td>D3310</td> <TD ALIGN=left>Anterior </TD> <TD ALIGN=right>$325.00</TD> <TD ALIGN=right>$675.00</TD> </TR> <TR> <td>D3320</td> <TD ALIGN=left>Bicuspid </TD> <TD ALIGN=right>$380.00</TD> <TD ALIGN=right>$775.00</TD> </TR> <TR> <td>D3330</td> <TD ALIGN=left>Molar </TD> <TD ALIGN=right>$565.00</TD> <TD ALIGN=right>$975.00</TD> </TR> </TABLE> </LEFT> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> </td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"><td width="6%"><u>ADA CODE</u></td> <TD WIDTH="59%" ALIGN=left><A NAME="P"></A> <U>PERIODONTICS PROCEDURES </U></TD> <TD WIDTH="20%" ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#009900"><U>NDPA FEE</U></TD> <TD WIDTH="20%" ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#009900"><U>USUAL FEE</U></TD> </TR> <TR> <td>D4341</td> <TD ALIGN=left>Periodontal scaling and root planing<br> (per quadrant)</TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000">$70.00</TD> <TD ALIGN=right><FONT SIZE="2" FACE="Arial" COLOR="#000000">$170.00</TD> </TR> <TR> <td>D4260</td> <TD ALIGN=left>Osseous or mucogingival surgery (per quadrant)</TD> <TD ALIGN=right>$450.00</TD> <TD ALIGN=right>$875.00</TD> </TR> <TR> <td>D4910</td> <TD ALIGN=left>Perio maintenance</TD> <TD ALIGN=right>$65.00</TD> <TD ALIGN=right>$95.00</TD> </TR> </TABLE> </LEFT> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER></td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000 height="163"> <TBODY> <TR class="head"><td width="6%"><u>ADA CODE</u></td> <TD WIDTH="59%" ALIGN=left height="18"><A NAME="O"></A> <U>ORAL SURGERY</U></TD> <TD WIDTH="20%" ALIGN=right height="18"><U>NDPA FEE</U></TD> <TD WIDTH="20%" ALIGN=right height="18"><U>USUAL FEE</U></TD> </TR> <TR> <td>D7111</td> <TD ALIGN=left height="18">Extraction, coronal remnants - deciduous tooth</TD> <TD ALIGN=right height="18">$60.00</TD> <TD ALIGN=right height="18">$165.00</TD> </TR> <TR> <td>D7140</td> <TD ALIGN=left height="18">Extraction, erupted tooth or exposed root</TD> <TD ALIGN=right height="18">$75.00</TD> <TD ALIGN=right height="18">$175.00</TD> </TR> <TR> <td>D7210</td> <TD ALIGN=left height="18">Surgical Extraction</TD> <TD ALIGN=right height="18">$125.00</TD> <TD ALIGN=right height="18">$230.00</TD> </TR> <TR> <td>D7220</td> <TD ALIGN=left height="18">Extraction - soft tissue impaction</TD> <TD ALIGN=right height="18">$125.00</TD> <TD ALIGN=right height="18">$245.00</TD> </TR> <TR> <td>D7230</td> <TD ALIGN=left height="19">Extraction - partial bony impaction</TD> <TD ALIGN=right height="19">$160.00</TD> <TD ALIGN=right height="19">$365.00</TD> </TR> <TR> <td>D7240</td> <TD ALIGN=left height="18">Extraction - full bony impaction</TD> <TD ALIGN=right height="18">$195.00</TD> <TD ALIGN=right height="18">$445.00</TD> </TR> <TR> <td>D7510</td> <TD ALIGN=left height="18">Incision and drainage of abscess</TD> <TD ALIGN=right height="18">$60.00</TD> <TD ALIGN=right height="18">$185.00</TD> </TR> </TBODY> </TABLE> </LEFT> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> </td> </tr> <tr> <td><TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000 id=TABLE1> <TR class="head"><td width="6%"><u>ADA CODE</u></td> <TD WIDTH="59%" ALIGN=left><A NAME="PF"></A> <U>FIXED PROSTHODONTICS</U></TD> <TD WIDTH="20%" ALIGN=right><U>NDPA FEE</U></TD> <TD WIDTH="20%" ALIGN=right><U>USUAL FEE</U></TD> </TR> <TR> <td>D6240</td> <TD ALIGN=left>Pontic - Porcelain fused to high noble metal</TD> <TD ALIGN=right>$590.00</TD> <TD ALIGN=right>$975.00</TD> </TR> <TR> <td>D6241</td> <TD ALIGN=left>Pontic - Porcelain fused to predominantly base metal</TD> <TD ALIGN=right>$410.00</TD> <TD ALIGN=right>$725.00</TD> </TR> <TR> <td>D6242</td> <TD ALIGN=left>Pontic - Porcelain fused to noble metal</TD> <TD ALIGN=right>$570.00</TD> <TD ALIGN=right>$945.00</TD> </TR> <TR> <td>D2750/D6750</td> <TD ALIGN=left>Crown - Porcelain fused to high noble meta</TD> <TD ALIGN=right>$590.00</TD> <TD ALIGN=right>$975.00</TD> </TR> <TR> <td>D2751/6751</td> <TD ALIGN=left>Crown - Porcelain fused to predominantly base metal</TD> <TD ALIGN=right>$410.00</TD> <TD ALIGN=right>$725.00</TD> </TR> <TR> <td>D2752/D6752</td> <TD ALIGN=left>Crown - Porcelain fused to noble metal</TD> <TD ALIGN=right>$570.00</TD> <TD ALIGN=right>$945.00</TD> </TR> <TR> <td>D2954/D6972</td> <TD ALIGN=left>Post and core (prefabricated)</TD> <TD ALIGN=right>$130.00</TD> <TD ALIGN=right>$245.00</TD> </TR> <TR> <td>D2950/6973</td> <TD ALIGN=left>Core buildup - including pins</TD> <TD ALIGN=right>$110.00</TD> <TD ALIGN=right>$175.00</TD> </TR> <TR> <td>D2952/D6970</td> <TD ALIGN=left>Post and core (non-gold) laboratory</TD> <TD ALIGN=right>$200.00</TD> <TD ALIGN=right>$345.00</TD> </TR> <TR> <td>D2920</td> <TD ALIGN=left>Recement crown</TD> <TD ALIGN=right>$35.00</TD> <TD ALIGN=right>$75.00</TD> </TR> <TR> <td>D2930</td> <TD ALIGN=left>Re-cement fixed bridge</TD> <TD ALIGN=right>$45.00</TD> <TD ALIGN=right>$85.00</TD> </TR> <TR> <td>D2999/D6999</td> <TD ALIGN=left>Temporary Crown (as part of crown procedure)</TD> <TD ALIGN=middle COLSPAN=2>NO CHARGE</TD> </TR> </TABLE> </LEFT> <CENTER> <A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> </CENTER> <HR> </td> </tr> <tr> <td> <TABLE CELLPADDING=2 CELLSPACING=2 WIDTH="95%" BORDER=0 BORDERCOLOR=#000000> <TR class="head"><td width="6%"><u>ADA CODE</u></td> <TD WIDTH="59%" ALIGN=left><A NAME="PR"></A> <U>REMOVABLE PROSTHODONTICS</U></TD> <TD WIDTH="20%" ALIGN=right><U>NDPA FEE</U></TD> <TD WIDTH="20%" ALIGN=right><U>USUAL FEE</U></TD> </TR> <TR> <td></td> <TD colspan="3" ALIGN=left><u><em>Complete Dentures</em> </u></TD> </TR> <TR> <td>D5110</td> <TD ALIGN=left>Complete maxillary denture (includ. adjustments)</TD> <TD ALIGN=right>$610.00</TD> <TD ALIGN=right>$1,200.00</TD> </TR> <TR> <td>D5120</td> <TD ALIGN=left>Complete mandibular denture (including adjustments)</TD> <TD ALIGN=right>$610.00</TD> <TD ALIGN="RIGHT">$1,200.00</TD> </TR> <TR> <td>D5410/D5411</td> <TD ALIGN=left>Denture adjustments (for dentures made at another office)</TD> <TD ALIGN=right>$35.00</TD> <TD ALIGN="RIGHT"><p align="right">$75.00</p></TD> </TR> <TR><td></td> <TD HEIGHT=30 ALIGN=left COLSPAN=3><U><I>Partial Dentures:</I></U></TD> </TR> <TR> <td>D5211-D5212</td> <TD ALIGN=left>Acrylic resin base (resin or wrought wire clasps)</TD> <TD ALIGN=right>$465.00</TD> <TD ALIGN=right>$875.00</TD> </TR> <TR> <td>D5213-D5214</td> <TD ALIGN=left>Cast metal framework with resin base</TD> <TD ALIGN=right>$660.00</TD> <TD ALIGN=right>$1,200.00</TD> </TR> <TR><td></td> <TD ALIGN=left><u><em>Denture Reline/Repair</em></u></TD> </TR> <TR> <td>D5730/D5731</td> <TD ALIGN=left>Reline denture (chairside)</TD> <TD ALIGN=right>$145.00</TD> <TD ALIGN=right>$265.00</TD> </TR> <TR> <td>D5750/D5751</td> <TD ALIGN=left>Reline denture (laboratory)</TD> <TD ALIGN=right>$200.00</TD> <TD ALIGN=right>$395.00</TD> </TR> <TR> <td>D5110</td> <TD ALIGN=left>Repair broken denture base (no teeth involved)</TD> <TD ALIGN=right>$80.00</TD> <TD ALIGN=right>$165.00</TD> </TR> <TR> <td>D5520</td> <TD ALIGN=left>Replace tooth on denture</TD> <TD ALIGN=right>$65.00</TD> <TD ALIGN=right>$135.00</TD> </TR> <TR> <td>D9940</td> <TD ALIGN=left>Occlusal guard</TD> <TD ALIGN=right>$280.00</TD> <TD ALIGN=right>$415.00</TD> </TR> <TR><td></td> <TD HEIGHT=30 ALIGN=left COLSPAN=3><U><I>Space Maintainers</I></U></TD> </TR> <TR> <td>D1520</td> <TD ALIGN=left>Unilateral - removable</TD> <TD ALIGN=right>$180.00</TD> <TD ALIGN=right>$295.00</TD> </TR> <TR> <td>D1525</td> <TD ALIGN=left>Bilateral - removable</TD> <TD ALIGN=right>$220.00</TD> <TD ALIGN=right>$345.00</TD> </TR> </TABLE> </LEFT> </td> </tr> <tr> <td align="center"><A href="#TOP"><IMG src="Graphics/backtotop_new.gif" border=0></A> <UL> <LI> Please Note: Rates are Subject to Periodic Change<BR> Without Prior Notification</LI> </UL> <A href="Southeastspecialist.htm">Southeast Specialist Fees</A> </td> </tr> </table> <!--#include file="feeBottom.asp"-->