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Careington 500 Full Fee Schedule
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). Please see the disclaimer below to understand how these discounts were calculated.
DIAGNOSTIC (Exams, X-Rays)
ADA Code |
Description |
Regular Costs |
Your Costs |
Your Savings
|
| 0120 | Periodic Oral Evaluation – Established Patient | $51 | $12 | 72% |
| 0140 | Limited Oral Evaluation – Problem Focused | $77 | $18 | 76% |
| 0150 | Comprehensive Oral Evaluation – New or Established Patient | $90 | $18 | 80% |
| 0210 | Intraoral – Complete Series (Including Bitewings) | $131 | $40 | 69% |
| 0220 | Intraoral – Periapical First Film | $29 | $10 | 65% |
| 0230 | Intraoral – Periapical Each Additional Film | $25 | $6 | 76% |
| 0270 | Bitewing – Single Film | $29 | $12 | 65% |
| 0272 | Bitewings – Two Films | $46 | $13 | 71% |
| 0273 | Bitewings – Three Films | $57 | $17 | 70% |
| 0274 | Bitewings – Four Films | $66 | $20 | 69% |
| 0330 | Panoramic Film | $110 | $40 | 63% |
Preventive (Cleanings, Etc.)
ADA Code |
Description |
Regular Costs |
Your Costs |
Your Savings
|
| 1110 | Prophylaxis – Adult | $92 | $29 | 68% |
| 1120 | Prophylaxis – Child | $67 | $21 | 68% |
| 1351 | Sealant – Per Tooth | $56 | $20 | 64% |
| 1510 | Space Maintainer – Fixed – Unilateral | $318 | $87 | 72% |
| 1515 | Space Maintainer – Fixed – Bilateral | $429 | $127 | 70% |
| 1520 | Space Maintainer – Removable – Unilateral | $389 | $113 | 70% |
| 1525 | Space Maintainer – Removable – Bilateral | $489 | $143 | 70% |
Restorative (Fillings)
ADA Code |
Description |
Regular Costs |
Your Costs |
Your Savings
|
| 2140 | Amalgam – 1 Surface, Primary or Permanent | $141 | $40 | 68% |
| 2150 | Amalgam – 2 Surfaces, Primary or Permanent | $180 | $51 | 68% |
| 2160 | Amalgam – 3 Surfaces, Primary or Permanent | $222 | $60 | 64% |
| 2161 | Amalgam – 4 or More Surfaces, Primary or Permanent | $260 | $73 | 72% |
| 2330 | Resin-Based Composite – 1 Surface, Anterior | $164 | $51 | 70% |
| 2331 | Resin-Based Composite – 2 Surfaces, Anterior | $202 | $61 | 70% |
| 2332 | Resin-Based Composite – 3 Surfaces, Anterior | $253 | $77 | 70% |
| 2335 | Resin-Based Composite – 4 or More Surfaces or Involving Incisal Angle (Anterior) | $314 | $98 | 70% |
| 2391 | Resin-Based Composite – 1 Surface, Posterior | $182 | $64 | 70% |
| 2392 | Resin-Based Composite – 2 Surfaces, Posterior | $235 | $94 | 70% |
| 2393 | Resin-Based Composite – 3 Surfaces, Posterior | $292 | $119 | 70% |
| 2394 | Resin-Based Composite – 4 or More Surfaces, Posterior | $347 | $138 | 70% |
Restorative (Crowns)
ADA Code |
Description |
Regular Costs |
Your Costs |
Your Savings
|
| 2710 | Crown – Resin-Based Composite (Indirect) | $970 | $191 | 80% |
| 2720 | Crown – Resin With High Noble Metal | $1066 | $403 | 62% |
| 2750 | Crown – Porcelain Fused to High Noble Metal | $1122 | $473 | 57% |
| 2751 | Crown – Porcelain Fused to Predominantly Base Metal | $1034 | $428 | 58% |
| 2752 | Crown – Porcelain Fused to Noble Metal | $1057 | $447 | 57% |
| 2790 | Crown – Full Cast High Noble Metal | $1128 | $465 | 58% |
| 2791 | Crown – Full Cast Predominantly Base Metal | $997 | $417 | 58% |
| 2930 | Prefabricated Stainless Steel Crown – Primary Tooth | $268 | $93 | 65% |
| 2931 | Prefabricated Stainless Steel Crown – Permanent Tooth | $327 | $106 | 67% |
| 2950 | Core Buildup, Including Any Pins | $268 | $93 | 65% |
| 2951 | Pin Retention – Per Tooth, In Addition To Restoration | $75 | $23 | 69% |
| 2952 | Post and Core in Addition to Crown, Indirectly Fabricated | $420 | $146 | 65% |
| 2954 | Prefabricated Post and Core in Addition to Crown | $335 | $114 | 65% |
ENDODONTICS (Root Canals, etc.)
ADA Code |
Description |
Regular Costs |
Your Costs |
Your Savings
|
| 3110 | Pulp Cap – Direct (Excluding Final Restoration) | $83 | $21 | 74% |
| 3120 | Pulp Cap – Indirect (Excluding Final Restoration) | $85 | $21 | 75% |
| 3220 | Therapeutic Pulpotomy (Excluding Final Restoration) – Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament |
$199 | $51 | 74% |
| 3310 | Endodontic Therapy, Anterior Tooth (Excluding Final Restoration) | $728 | $272 | 62% |
| 3320 | Endodontic Therapy, Bicuspid Tooth (Excluding Final Restoration) | $839 | $322 | 61% |
| 3330 | Endodontic Therapy, Molar (Excluding Final Restoration) | $1017 | $406 | 60% |
PERIODONTICS (Scaling / Deep Cleaning / Root Planing, etc.)
ADA Code |
Description |
Regular Costs |
Your Costs |
Your Savings
|
| 4210 | Gingivectomy or Gingivoplasty – Four or More Contiguous Teeth or Tooth Bounded Spaces per Quadrant |
$635 | $271 | 57% |
| 4341 | Periodontal Scaling and Root Planing – Four or More Teeth per Quadrant | $259 | $94 | 63% |
| 4910 | Periodontal Maintenance | $140 | $60 | 57% |
PROSTHODONTICS (Dentures – Removable, Partials, etc.)
ADA Code |
Description |
Regular Costs |
Your Costs |
Your Savings
|
| 5110 | Complete Denture – Maxillary | $1715 | $595 | 65% |
| 5120 | Complete Denture – Mandibular | $1715 | $595 | 65% |
| 5130 | Immediate Denture – Maxillary | $1833 | $619 | 66% |
| 5140 | Immediate Denture – Mandibular | $1833 | $619 | 66% |
| 5211 | Maxillary Partial Denture – Resin Base (Including Any Conventional Clasps, Rests and Teeth) | $1360 | $583 | 57% |
| 5212 | Mandibular Partial Denture – Resin Base (Including Any Conventional Clasps, Rests and Teeth) | $1363 | $583 | 57% |
| 5213 | Maxillary Partial Denture – Cast Metal Framework with Resin Denture Bases (Including Any Conventional Clasps, Rests and Teeth) | $1784 | $675 | 62% |
| 5214 | Mandibular Partial Denture – Cast Metal Framework with Resin Denture Bases (Including Any Conventional Clasps, Rests and Teeth) | $1786 | $675 | 62% |
| 5410 | Adjust Complete Denture – Maxillary | $90 | $34 | 62% |
| 5411 | Adjust Complete Denture – Mandibular | $90 | $34 | 62% |
| 5510 | Repair Broken Complete Denture Base | $212 | $53 | 75% |
| 5520 | Replace Missing or Broken Teeth – Complete Denture (Each Tooth) | $188 | $51 | 72% |
| 5630 | Repair or Replace Broken Clasp | $264 | $61 | 76% |
| 5650 | Add Tooth to Existing Partial Denture | $223 | $53 | 76% |
| 5660 | Add Clasp to Existing Partial Denture | $272 | $68 | 75% |
| 5730 | Reline Complete Maxillary Denture (Chairside) | $374 | $126 | 66% |
| 5731 | Reline Complete Mandibular Denture (Chairside) | $372 | $126 | 66% |
| 5740 | Reline Maxillary Partial Denture (Chairside) | $367 | $120 | 67% |
| 5741 | Reline Mandibular Partial Denture (Chairside) | $372 | $120 | 67% |
| 5750 | Reline Complete Maxillary Denture (Laboratory) | $479 | $165 | 65% |
| 5751 | Reline Complete Mandibular Denture (Laboratory) | $479 | $165 | 65% |
PROSTHODONTICS – FIXED (Bridges, Dentures, etc.)
ADA Code |
Description |
Regular Costs |
Your Costs |
Your Savings
|
| 6040 | Surgical Placement: Eposteal Implant | $8157 | 20% Off | $1631 |
| 6050 | Surgical Placement: Transosteal Implant | $5640 | 20%o Off | $1128 |
| 6065 | Implant Supported Porcelain/Ceramic Crown | $1562 | 20% Off | $312 |
| 6066 | Implant Supported Porcelain Fused to Metal Crown (Titanium, Titanium Alloy, High Noble Metal) | $1565 | 20% Off | $313 |
| 6067 | Implant Supported Metal Crown (Titanium, Titanium Alloy, High Noble Metal) | $1585 | 20% Off | $317 |
| 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 |
Description |
Regular Costs |
Your Costs |
Your 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 | $227 | $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 |
Description |
Regular Costs |
Your Costs |
Your Savings
|
| 8070 | Comprehensive Orthodontic Treatment of the Transitional Dentition | $5174 | 20% Off | $1029 |
| 8080 | Comprehensive Orthodontic Treatment of the Adolescent Dentition | $5200 | 20% Off | $1040 |
| 8090 | Comprehensive Orthodontic Treatment of the Adult Dentition | $5225 | 20% Off | $1045 |
ADJUNCTIVE SERVICES (Anesthesia, Analgesia, etc.)
ADA Code |
Description |
Regular Costs |
Your Costs |
Your Savings
|
| 9110 | Palliative (Emergency) Treatment of Dental Pain – Minor Procedure | $130 | $34 | 73% Off |
| 9215 | Local Anesthesia in Conjunction with Operative or Surgical Proceduresn | $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 |
Disclaimer
* 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.
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.
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.