DentalGuard Orthodontic Fee Schedule and Guidelines. DentalGuard Orthodontic Fee Schedule and Guidelines. Code Description Max. Allowable Fee D$ Pre-orthodontic treatment visit. Orthodontic evaluation and consultation Orthodontic treatment plan and records, including radiographs, study models and photos $ D/D D/D D Comprehensive Ortho Treatment-Adult (24 months) $4, $5, 21% D Ceramic (Clear) Braces - Upper Teeth $ $ 50% Ceramic (Clear) Braces - Upper and Lower Teeth $ $ 50% Damon Brackets $4, Specialty Fee Schedule (Enrollment in the Greenberg Dental & Orthodontics Discount Dental Plan for.
64 rows · Dental Fee Schedule Dental Fee Schedule Any treatment performed by a participating . The Dental Care Cost Estimator provides an estimate and does not guarantee the exact fees for dental procedures, what services your dental benefits plan will cover or your out-of-pocket costs. Estimates should not be construed as financial or medical advice. For more detailed information on your actual dental care costs, please consult your.
Orthodontics. Delta Dental’s allowance for orthodontic procedures includes all appliances, adjustments, insertion, removal and post-treatment stabilization (retention). Orthodontic Treatment Claims. Be sure to include: Total fee (including the initial fee/down payment and monthly payment amounts) Banding date; Type of appliance. The customary way of determining the adult fee schedule is to put a surcharge on the child fees, perhaps $ or $ An adult fee schedule derived from the above child fee schedule, with a $ surcharge, would be: 12 ± 3 months $2, ; 18 ± 3 months $3, ; 24 ± 3 months $3, ; 30 ± 3 months $3, ; 36 ± 3 months $4,
30% of PDP fees** 50% of PDP fees* 50% of PDP fees** Cosmetic Procedures $Labial veneers (bonding) Tooth bleaching $ $/Arch R&C less 25% $/Arch R&C less 25% N/A N/A N/A N/A N/A N/A N/A N/A tYPe D Orthodontia (braces) Evaluation Treatment plan & records Child Adult Lifetime maximum benefit per person $35 $ $ $ N/A $0 $