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| Ameriplan Red Fee Zip: 80123 | |||||||||
SPECIALIST FEE SCHEDULE Any AmeriPlan®/Dental Plans of America™ 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:
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| ADA Code | Sample General Dentist Procedures | Dental Office Fees Up To* | AmeriPlan® Fees | AmeriPlan® 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% | |||||
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*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 realized by AmeriPlan® members. Fees will vary by region. |
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