Know your treatment costs ahead-of-time, or verify charges for treatment, by using this list of approved procedures. The 89,000 dentists in the Careington 500 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	$14	72% off
0140	limited oral evaluation - problem focused	$77	$18	76% off
0150	comprehensive oral evaluation - new or established patient	$90	$18	80% off
0210	intraoral - complete series (including bitewings)	$131	$40	69% off
0220	intraoral - periapical first film	$29	$10	65% off
0230	intraoral - periapical each additional film	$25	$6	76% off
0270	bitewing - single film	$29	$10	65% off
0272	bitewings - two films	$46	$13	71% off
0273	bitewings - three films	$57	$17	70% off
0274	bitewings - four films	$66	$20	69% off
0330	panoramic film	$110	$40	63% off
PREVENTIVE (Cleanings, etc.)
ADA code	Procedure	Typical Fee	You Pay	Savings
1110	prophylaxis - adult	$92	$29	68% off
1120	prophylaxis - child	$67	$21	68% off
1351	sealant - per tooth	$56	$20	64% off
1510	space maintainer - fixed - unilateral	$318	$87	72% off
1515	space maintainer - fixed - bilateral	$429	$127	70% off
1520	space maintainer - removable - unilateral	$389	$113	70% off
1525	space maintainer - removable - bilateral	$489	$143	70% off
RESTORATIVE (Fillings)
ADA code	Procedure	Typical Fee	You Pay	Savings
2140	amalgam - one surface, primary or permanent	$141	$40	71% off
2150	amalgam - two surfaces, primary or permanent	$180	$51	71% off
2160	amalgam - three surfaces, primary or permanent	$222	$60	72% off
2161	amalgam - four or more surfaces, primary or permanent	$260	$73	71% off
2330	resin-based composite - one surface, anterior	$164	$51	68% off
2331	resin-based composite - two surfaces, anterior	$202	$61	69% off
2332	resin-based composite - three surfaces, anterior	$253	$77	69% off
2335	resin-based composite - four or more surfaces or involving incisal angle (anterior)	$314	$98	68% off
2391	resin-based composite - one surface, posterior	$182	$64	64% off
2392	resin-based composite - two surfaces, posterior	$235	$94	60% off
2393	resin-based composite - three surfaces, posterior	$292	$119	59% off
2394	resin-based composite - four or more surfaces, posterior	$347	$138	60% off
RESTORATIVE (Crowns)
ADA code	Procedure	Typical Fee	You Pay	Savings
2710	crown - resin-based composite (indirect)	$970	$191	80% off
2720	crown - resin with high noble metal	$1066	$403	62% off
2750	crown - porcelain fused to high noble metal	$1122	$473	57% off
2751	crown - porcelain fused to predominantly base metal	$1034	$428	58% off
2752	crown - porcelain fused to noble metal	$1057	$447	57% off
2790	crown - full cast high noble metal	$1128	$465	58% off
2791	crown - full cast predominantly base metal	$997	$417	58% off
2930	prefabricated stainless steel crown - primary tooth	$268	$93	65% off
2931	prefabricated stainless steel crown - permanent tooth	$327	$106	67% off
2950	core buildup, including any pins	$268	$93	65% off
2951	pin retention - per tooth, in addition to restoration	$75	$23	69% off
2952	post and core in addition to crown, indirectly fabricated	$420	$146	65% off
2954	prefabricated post and core in addition to crown	$335	$114	65% off
ENDODONTICS (Root Canals, etc.)
ADA code	Procedure	Typical Fee	You Pay	Savings
3110	pulp cap - direct (excluding final restoration)	$83	$21	74% off
3120	pulp cap - indirect (excluding final restoration)	$85	$21	75% off
3220	therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament	$199	$51	74% off
3310	endodontic therapy, anterior tooth (excluding final restoration)	$728	$272	62% off
3320	endodontic therapy, bicuspid tooth (excluding final restoration)	$839	$322	61% off
3330	endodontic therapy, molar (excluding final restoration)	$1017	$406	60% 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	$635	$271	57% off
4341	periodontal scaling and root planing - four or more teeth per quadrant	$259	$94	63% off
4910	periodontal maintenance	$140	$60	57% off
PROSTHODONTICS (Dentures - Removable, Partials, etc.)
ADA code	Procedure	Typical Fee	You Pay	Savings
5110	complete denture - maxillary	$1715	$595	65% off
5120	complete denture - mandibular	$1715	$595	65% off
5130	immediate denture - maxillary	$1833	$619	66% off
5140	immediate denture - mandibular	$1833	$619	66% off
5211	maxillary partial denture - resin base (including any conventional clasps, rests and teeth)	$1360	$583	57% off
5212	mandibular partial denture - resin base (including any conventional clasps, rests and teeth)	$1363	$583	57% off
5213	maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)	$1784	$675	62% off
5214	mandibular partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)	$1786	$675	62% off
5410	adjust complete denture - maxillary	$90	$34	62% off
5411	adjust complete denture - mandibular	$90	$34	62% off
5510	repair broken complete denture base	$212	$53	75% off
5520	replace missing or broken teeth - complete denture (each tooth)	$188	$51	72% off
5630	repair or replace broken clasp	$264	$61	76% off
5650	add tooth to existing partial denture	$223	$53	76% off
5660	add clasp to existing partial denture	$272	$68	75% off
5730	reline complete maxillary denture (chairside)	$374	$126	66% off
5731	reline complete mandibular denture (chairside)	$372	$126	66% off
5740	reline maxillary partial denture (chairside)	$367	$120	67% off
5741	reline mandibular partial denture (chairside)	$372	$120	67% off
5750	reline complete maxillary denture (laboratory)	$479	$165	65% off
5751	reline complete mandibular denture (laboratory)	$479	$165	65% off
PROSTHODONTICS - FIXED (Bridges, Dentures, etc.)
ADA code	Procedure	Typical Fee	You Pay	Savings
6040	surgical placement: eposteal implant	$8157	20% Discount	$1631 off
6050	surgical placement: transosteal implant	$5640	20% Discount	$1128 off
6065	implant supported porcelain/ceramic crown	$1562	20% Discount	$312 off
6066	implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal)	$1565	20% Discount	$313 off
6067	implant supported metal crown (titanium, titanium alloy, high noble metal)	$1585	20% Discount	$317 off
6240	pontic - porcelain fused to high noble metal	$1119	$411	63% off
6241	pontic - porcelain fused to predominantly base metal	$1034	$379	63% off
6242	pontic - porcelain fused to noble metal	$1061	$395	62% off
6750	crown - porcelain fused to high noble metal	$1123	$453	59% off
6751	crown - porcelain fused to predominantly base metal	$1017	$408	59% off
6752	crown - porcelain fused to noble metal	$1051	$424	59% off
ORAL SURGERY (Tooth Extractions, etc.)
ADA code	Procedure	Typical Fee	You Pay	Savings
7140	extraction, erupted tooth or exposed root (elevation and/or forceps removal)	$174	$51	70% off
7210	surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated	$277	$130	53% off
7220	removal of impacted tooth - soft tissue	$313	$104	66% off
7230	removal of impacted tooth - partially bony	$397	$136	65% off
7240	removal of impacted tooth - completely bony	$484	$196	59% off
7250	surgical removal of residual tooth roots (cutting procedure)	$313	$104	66% off
7310	alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant	$306	$87	71% off
7320	alveoloplasty not in conjunction with extractions -four or more teeth or tooth spaces, per quadrant	$447	$125	72% off
7510	incision and drainage of abscess - intraoral soft tissue	$235	$64	72% off
ORTHODONTICS (Braces - Children and Adults, etc.)
ADA code	Procedure	Typical Fee	You Pay	Savings
8070	comprehensive orthodontic treatment of the transitional dentition	$5147	20% Discount	$1029 off
8080	comprehensive orthodontic treatment of the adolescent dentition	$5200	20% Discount	$1040 off
8090	comprehensive orthodontic treatment of the adult dentition	$5225	20% Discount	$1045 off
ADJUNCTIVE SERVICES (Anesthesia, Analgesia, etc.)
ADA code	Procedure	Typical Fee	You Pay	Savings
9110	palliative (emergency) treatment of dental pain - minor procedure	$130	$34	73% off
9215	local anesthesia in conjunction with operative or surgical procedures	$66	$12	81% off
9230	inhalation of nitrous oxide / anxiolysis, analgesia	$80	$24	70% off
9951	occlusal adjustment - limited	$188	$47	75% off
9952	occlusal adjustment - complete	$702	$188	73% off
DISCLAIMERS
* Typical fees based on the 80th percentile of the National Dental Advisory Service Comprehensive Fee Report for 2012 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. 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. Fee schedules are subject to change without prior notification to members. Procedures not listed on this schedule will be discounted at 20% off of the General Dentist's normal fee. If the General Dentist's normal fee for any procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that procedure. [back to top of schedule] Lab Fees Any procedure involving lab fees will incur additional costs. All applicable lab fees are the full responsibility of the member and are subject to no discount. [back to top of schedule] 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 International, Attn. Provider Relations, PO Box 2568, Frisco, Texas 75034. Please call 800-372-7615 if you have any further questions. [back to top of schedule]