Data Trends in Dentistry. Dental Fees. Results from the 2013 Survey of Dental Fees

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1 Data Trends in Dentistry Dental s Results from the 2013 Survey of Dental s

2 2013 Survey of Dental s Table of Contents General Practitioners National... 3 New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) Middle Atlantic (New Jersey, New York, Pennsylvania) East North Central (Illinois, Indiana, Michigan, Ohio, Wisconsin) West North Central (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota) South Atlantic (Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, Washington D.C., West Virginia) East South Central (Alabama, Kentucky, Mississippi, Tennessee) West South Central (Arkansas, Louisiana, Oklahoma, Texas) Mountain (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming) Pacific (Alaska, California, Hawaii, Oregon, Washington) Specialists Oral and Maxillofacial Surgeons Endodontists Orthodontists and Dentofacial Orthopedists Pediatric Dentists Periodontists Prosthodontists Appendix Methodology Glossary Survey Instrument Important Note: The survey data should not be interpreted as constituting a fee schedule in any way, and should not be used for that purpose. Dentists must establish their own fees based on their individual practice and market considerations. The American Dental Association discourages dentists from engaging in any unlawful concerted activity regarding fees or otherwise. Copyright 2014 American Dental Association.

3 2013 Survey of Dental s General Practitioners - National Procedure D0120 Periodic oral evaluation established patient ,235 D0140 Limited oral evaluation - problem focused ,209 D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver D0150 Comprehensive oral evaluation - new or established patient ,218 D0160 Detailed and extensive oral evaluation - problem focused, by report D0170 Re-evaluation - limited, problem focused (established patient; not post-operative visit) D0180 Comprehensive periodontal evaluation - new or established patient D0190 Screening of a patient D0191 Assessment of a patient D0210 Intraoral - complete series of radiographic images ,147 D0220 Intraoral - periapical first radiographic image ,227 D0230 Intraoral - periapical each additional radiographic image ,213 D0272 Bitewings - two radiographic images ,173 D0273 Bitewings - three radiographic images D0274 Bitewings - four radiographic images ,166 D0277 Vertical bitewings - 7 to 8 radiographic images D0330 Panoramic radiographic image D0350 Oral/facial photographic images Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 3

4 2013 Survey of Dental s General Practitioners - National Procedure D0363 Cone beam 3D image reconstruction using existing data, includes multiple images Collection and preparation of saliva sample for laboratory diagnostic testing D0417 D0418 Analysis of saliva sample Adjunctive pre-diagnostic test that aids in D0431 detection of mucosal abnormalities D0470 Diagnostic casts D1110 Prophylaxis - adult ,236 D1120 Prophylaxis - child ,211 D1206 Topical fluoride varnish D1208 Topical application of fluoride D1320 Tobacco counseling for the control and prevention of oral disease D1330 Oral hygiene instructions D1351 Sealant - per tooth ,144 D1352 Preventive resin restoration in a moderate to high caries risk patient - permanent tooth D1510 Space maintainer - fixed - unilateral D1515 Space maintainer - fixed - bilateral D2140 Amalgam - one surface, primary or permanent ,005 D2150 Amalgam - two surfaces, primary or permanent ,001 D2160 Amalgam - three surfaces, primary or permanent D2161 Amalgam - four or more surfaces, primary or permanent D2330 Resin-based composite - one surface, anterior ,201 Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 4

5 2013 Survey of Dental s General Practitioners - National Procedure D2331 D2332 Resin-based composite - two surfaces, anterior ,208 Resin-based composite - three surfaces, anterior ,211 Resin-based composite - four or more surfaces or involving incisal angle (anterior) ,199 D2335 D2390 Resin-based composite crown, anterior Resin-based composite - one surface, D2391 posterior ,179 Resin-based composite - two surfaces, D2392 posterior ,186 Resin-based composite - three surfaces, D2393 posterior ,181 Resin-based composite - four or more D2394 surfaces, posterior ,140 D2520 Inlay - metallic - two surfaces ,025 1,092 1, D2543 Onlay - metallic - three surfaces ,052 1,093 1,150 1,206 1, D2620 Inlay - porcelain/ceramic - two surfaces ,019 1,075 1,148 1, D2642 Onlay - porcelain/ceramic - two surfaces ,050 1,100 1,136 1,200 1, D2643 Onlay - porcelain/ceramic - three surfaces ,100 1,137 1,175 1,225 1, D2644 Onlay - porcelain/ceramic - four or more surfaces 1, ,000 1,148 1,177 1,204 1,250 1, D2651 Inlay - resin-based composite - two surfaces ,075 1, D2662 Onlay - resin-based composite - two surfaces ,000 1,061 1,113 1, D2663 Onlay - resin-based composite - three surfaces ,047 1,080 1,140 1, D2664 Onlay - resin-based composite - four or more surfaces ,041 1,075 1,114 1,200 1, D2710 Crown, resin-based composite (indirect) ,075 1, Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 5

6 2013 Survey of Dental s General Practitioners - National Procedure D2740 Crown - porcelain/ceramic substrate 1, ,045 1,195 1,221 1,270 1,309 1,442 1,076 Crown - porcelain fused to high noble D2750 metal 1, ,017 1,152 1,200 1,250 1,295 1,395 1,114 Crown - porcelain fused to predominantly D2751 base metal ,050 1,099 1,138 1,200 1, D2752 Crown - porcelain fused to noble metal 1, ,100 1,148 1,195 1,250 1, D2780 Crown - 3/4 cast high noble metal 1, ,165 1,200 1,236 1,295 1, D2783 Crown - 3/4 porcelain/ceramic 1, ,010 1,160 1,200 1,234 1,295 1, D2790 Crown - full cast high noble metal 1, ,036 1,200 1,225 1,269 1,325 1,450 1,040 Provisional crown further treatment or completion of diagnosis necessary prior to D2799 final impression D2920 Recement crown ,166 Prefabricated porcelain/ceramic crown D2929 primary tooth Prefabricated stainless steel crown - D2930 primary tooth Prefabricated stainless steel crown - D2931 permanent tooth D2940 Protective restoration D2950 Core buildup, including any pins ,145 Post and core in addition to crown; D2952 indirectly fabricated Prefabricated post and core in addition to D2954 crown ,095 D2961 Labial veneer (resin laminate) - laboratory ,009 1,061 1,130 1, D2962 Labial veneer (porcelain laminate) - laboratory 1, ,010 1,190 1,217 1,275 1,334 1,458 1,020 D2970 Temporary crown (fractured tooth) D2981 Inlay repair necessitated by restorative material failure Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 6

7 2013 Survey of Dental s General Practitioners - National Procedure D2982 D2983 D2990 D3110 D3120 D3220 D3221 D3222 D3230 D3240 D3310 D3320 D3330 D3331 Onlay repair necessitated by restorative material failure Veneer repair necessitated by restorative material failure Resin infiltration of incipient smooth surface lesions Pulp cap - direct (excluding final restoration) Pulp cap - indirect (excluding final restoration) Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament ,002 Pulpal debridement, primary and permanent teeth Partial pulpotomy for apexogenesis - permanent tooth with incomplete root development Pulpal therapy (resorbable filling) - anterior, primary tooth (excluding final restoration) Pulpal therapy (resorbable filling) - posterior, primary tooth (excluding final restoration) Endodontic therapy, anterior tooth (excluding final restoration) ,071 Endodontic therapy, bicuspid tooth (excluding final restoration) ,062 1,069 Endodontic therapy, molar (excluding final restoration) ,061 1,098 1,125 1,188 1,274 1,033 Treatment of root canal obstruction; nonsurgical access Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 7

8 2013 Survey of Dental s General Practitioners - National Procedure D3332 D3346 D3347 D3348 D3351 D3352 D3353 D3354 D3410 D3421 D3425 D4210 Incomplete endodontic therapy; inoperable, unrestorable or fractured tooth Retreatment of previous root canal therapy - anterior ,020 1, Retreatment of previous root canal therapy - bicuspid ,000 1,025 1,068 1,140 1, Retreatment of previous root canal therapy - molar 1, ,045 1,180 1,207 1,260 1,350 1, Apexification/recalcification/pulpal regeneration - initial visit (apical closure/calcific repair of perforations, root resorption, pulp spa Apexification/recalcification/pulpal regeneration - interim medication replacement Apexification/recalcification/pulpal regeneration - final visit (includes completed root canal therapy) Pulpal regeneration - (completion of regenerative treatment in an immature permanent tooth with a necrotic pulp); does not include final res Apicoectomy/periradicular surgery - anterior Apicoectomy/periradicular surgery - bicuspid (first root) , Apicoectomy/periradicular surgery - molar (first root) ,045 1, Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 8

9 2013 Survey of Dental s General Practitioners - National Procedure D4211 D4212 D4240 Gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quadrant Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth Gingival flap procedure, including root planing four or more contiguous teeth or tooth bounded spaces per quadrant Gingival flap procedure, including root planing one to three contiguous teeth or tooth bounded spaces per quadrant D4241 D4249 Clinical crown lengthening - hard tissue , D4260 Osseous surgery (including flap entry and closure) - four or more contiguous teeth or tooth bounded spaces per quadrant ,135 1,190 1,217 1,288 1, D4261 Osseous surgery (including flap entry and closure) - one to three contiguous teeth or tooth bounded spaces per quadrant , D4263 Bone replacement graft - first site in quadrant D4264 Bone replacement graft each additional site in quadrant D4266 Guided tissue regeneration resorbable barrier, per site D4267 Guided tissue regeneration nonresorbable barrier, per site (includes membrane removal) ,010 1, D4273 Subepithelial connective tissue graft procedures, per tooth ,100 1,124 1,199 1,272 1, D4275 Soft tissue allograft ,010 1,100 1,213 1, Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 9

10 2013 Survey of Dental s General Practitioners - National Procedure Free soft tissue graft procedure (including donor site surgery), first tooth or D4277 edentulous tooth position in graft ,000 1, D4321 Provisional splinting - extracoronal Periodontal scaling and root planing - four D4341 or more teeth per quadrant ,092 Periodontal scaling and root planing - one D4342 to three teeth per quadrant Full mouth debridement to enable D4355 comprehensive evaluation and diagnosis ,055 Localized delivery of antimicrobial agents via a controlled release vehicle into D4381 diseased crevicular tissue, per tooth D4910 Periodontal maintenance ,058 D5110 Complete denture - maxillary 1, ,200 1,450 1,692 1,760 1,836 1,950 2,133 1,179 D5120 Complete denture - mandibular 1, ,000 1,200 1,450 1,700 1,761 1,837 1,955 2,158 1,179 D5130 Immediate denture - maxillary 1, ,050 1,275 1,530 1,800 1,850 1,950 2,041 2,285 1,139 D5140 Immediate denture - mandibular 1, ,050 1,275 1,528 1,800 1,852 1,950 2,041 2,300 1,139 D5211 Maxillary partial denture - resin base (including any conventional clasps, rests, and teeth) 1, ,061 1,350 1,400 1,500 1,606 1,876 1,054 D5212 Mandibular partial denture - resin base (including any conventional clasps, rests, and teeth) 1, ,076 1,350 1,415 1,500 1,626 1,876 1,053 D5213 Maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests, and teeth) 1, ,050 1,297 1,520 1,779 1,839 1,900 2,000 2,223 1,158 D5214 Mandibular partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests, and teeth) 1, ,050 1,298 1,523 1,785 1,850 1,902 2,000 2,242 1,160 D5225 Maxillary partial denture - flexible base (including any clasps, rests, and teeth) 1, ,071 1,341 1,552 1,600 1,680 1,800 2, Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 10

11 2013 Survey of Dental s General Practitioners - National Procedure D5226 Mandibular partial denture - flexible base (including any clasps, rests, and teeth) 1, ,065 1,348 1,565 1,600 1,695 1,827 2, D5510 Repair broken complete denture base ,023 D5520 Replace missing or broken teeth - complete denture (each tooth) ,051 D5610 Repair resin denture base D5640 Replace broken teeth - per tooth ,052 D5650 Add tooth to existing partial denture ,068 D5660 Add clasp to existing partial denture ,013 D5710 Rebase complete maxillary denture D5730 Reline complete maxillary denture (chairside) D5731 Reline complete mandibular denture (chairside) D5750 Reline complete maxillary denture (laboratory) ,134 D5751 Reline complete mandibular denture (laboratory) ,126 D6010 Surgical placement of implant body: endosteal implant 1, ,275 1,540 1,800 2,000 2,021 2,150 2,225 2, D6012 Surgical placement of interim implant body for transitional prosthesis: endosteal implant 1, ,200 1,500 1,750 1,800 1,850 2,100 2, D6051 Interim abutment D6053 Implant/abutment supported removable denture for completely edentulous arch 2, ,100 1,603 2,185 2,786 2,939 3,175 3,400 4, D6055 Connecting bar - implant supported or abutment supported 2, , ,800 2,812 3,000 3,200 3,613 4, D6056 Prefabricated abutment includes modification and placement , D6057 Custom fabricated abutment - includes placement ,000 1,061 1, Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 11

12 2013 Survey of Dental s General Practitioners - National Procedure D6059 D6066 Abutment supported porcelain fused to metal crown (high noble metal) 1, ,060 1,258 1,475 1,519 1,597 1,700 1, Implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) 1, ,100 1,300 1,553 1,620 1,716 1,821 2, D6069 Abutment supported retainer for porcelain fused to metal FPD (high noble metal) 1, ,087 1,270 1,470 1,500 1,600 1,692 1, D6076 Implant supported retainer for porcelain fused to metal FPD (titanium, titanium alloy, or high noble metal) 1, ,100 1,320 1,600 1,656 1,758 1,850 2, D6080 Implant maintenance procedures, including removal of prosthesis, cleansing of prosthesis and abutments and reinsertion of prosthesis D6104 Bone graft at time of implant placement D6205 Pontic - indirect resin based composite ,006 1,075 1,124 1,200 1, D6210 Pontic - cast high noble metal 1, ,000 1,150 1,196 1,234 1,295 1, D6240 Pontic - porcelain fused to high noble metal 1, ,150 1,195 1,224 1,282 1,370 1,064 D6241 Pontic - porcelain fused to predominantly base metal ,053 1,100 1,144 1,200 1, D6245 Pontic - porcelain/ceramic 1, ,025 1,170 1,200 1,250 1,295 1, D6253 Provisional pontic further treatment or completion of diagnosis necessary prior to final impression D6545 Retainer - cast metal for resin bonded fixed prosthesis ,002 1, D6710 Crown - indirect resin based composite ,032 1,075 1,127 1,167 1, D6750 Crown - porcelain fused to high noble metal 1, ,009 1,159 1,200 1,248 1,300 1,394 1,041 D6751 Crown - porcelain fused to predominantly base metal ,050 1,100 1,150 1,200 1, D6790 Crown - full cast high noble metal 1, ,007 1,167 1,200 1,250 1,300 1, Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 12

13 2013 Survey of Dental s General Practitioners - National Procedure Provisional retainer crown - further treatment or completion of diagnosis D6793 necessary prior to final impression D6930 Recement fixed partial denture Extraction, coronal remnants - deciduous D7111 tooth Extraction, erupted tooth or exposed root D7140 (elevation and/or forceps removal) ,181 Surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including D7210 elevation of mucoperiosteal flap ,039 D7220 Removal of impacted tooth - soft tissue D7230 Removal of impacted tooth - partially bony D7240 Removal of impacted tooth - completely bony D7250 Surgical removal of residual tooth roots (cutting procedure) D7251 Coronectomy - intentional partial tooth removal D7286 Biopsy of oral tissue - soft D7287 Exfoliative cytological sample collection D7288 Brush biopsy - transepithelial sample collection D7310 Alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant D7320 Alveoloplasty not in conjunction with extractions - four or more teeth or tooth spaces, per quadrant D7410 Excision of benign lesion up to 1.25 cm D7440 Excision of malignant tumor - lesion diameter up to 1.25 cm , Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 13

14 2013 Survey of Dental s General Practitioners - National Procedure Removal of benign odontogenic cyst or D7450 tumor - lesion diameter up to 1.25 cm D7880 Occlusal orthotic device, by report ,100 1, D7910 Suture of recent small wounds up to 5 cm D7953 Bone replacement graft for ridge preservation per site D7960 Frenulectomy (frenectomy or frenotomy) - separate procedure not incidental to another D7970 Excision of hyperplastic tissue - per arch D8020 Limited orthodontic treatment of the transitional dentition 1, , ,029 2,004 2,533 2,794 3,046 3,407 3, D8030 Limited orthodontic treatment of the adolescent dentition 2, , ,430 2,455 3,257 3,500 3,600 3,900 4, D8040 Limited orthodontic treatment of the adult dentition 2, , ,622 2,813 3,580 3,790 4,000 4,300 4, D8050 Interceptive orthodontic treatment of the primary dentition 2, , ,200 2,200 2,709 2,995 3,203 3,500 4, D8060 Interceptive orthodontic treatment of the transitional dentition 2, , ,100 2,145 2,875 3,000 3,224 3,600 4, D8070 Comprehensive orthodontic treatment of the transitional dentition 4, , ,500 4,000 4,800 5,413 5,518 5,775 6,000 6, D8080 Comprehensive orthodontic treatment of the adolescent dentition 4, ,767 4,344 4,950 5,405 5,500 5,717 5,900 6, D8090 Comprehensive orthodontic treatment of the adult dentition 5, ,150 4,500 5,035 5,511 5,670 5,900 6,064 6, D8670 Periodic orthodontic treatment visit (as part of contract) D8690 Orthodontic treatment (alternative billing to a contract fee) D8692 Replacement of lost or broken retainer D9110 Palliative (emergency) treatment of dental pain - minor procedure ,094 Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 14

15 2013 Survey of Dental s General Practitioners - National Procedure D9120 Fixed partial denture sectioning Local anesthesia in conjunction with D9215 operative or surgical procedures Inhalation of nitrous oxide/analgesia, D9230 anxiolysis Intravenous conscious sedation/analgesia D first 30 minutes D9242 Intravenous conscious sedation/analgesia - each additional 15 minutes D9248 Non-intravenous conscious sedation D9310 Consultation (diagnostic service provided by dentist or physician other than requesting dentist or physician) D9410 House/extended care facility call D9420 Hospital or ambulatory surgical center call D9430 Office visit for observation (during regularly scheduled hours) - no other services performed D9440 Office visit - after regularly scheduled hours D9450 Case presentation, detailed and extensive treatment planning D9610 Therapeutic parenteral drug, single administration D9630 Other drugs and/or medicaments, by report D9910 Application of desensitizing medicament D9911 Application of desensitizing resin for cervical and/or root surface, per tooth D9920 Behavior management, by report Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 15

16 2013 Survey of Dental s General Practitioners - National Procedure Treatment of complications (postsurgical) - unusual circumstances, by report D9930 D9940 Occlusal guard, by report ,091 D9941 Fabrication of athletic mouthguard D9951 Occlusal adjustment - limited D9952 Occlusal adjustment - complete D9972 External bleaching - per arch - performed in office D9974 Internal bleaching - per tooth D9975 External bleaching for home application, per arch; includes materials and fabrication of custom trays Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 16

17 Procedure D Survey of Dental s General Practitioners - New England Division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) Periodic oral evaluation established patient D0140 Limited oral evaluation - problem focused D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver D0150 Comprehensive oral evaluation - new or established patient D0160 Detailed and extensive oral evaluation - problem focused, by report D0170 Re-evaluation - limited, problem focused (established patient; not post-operative visit) D0180 Comprehensive periodontal evaluation - new or established patient D0210 Intraoral - complete series of radiographic images D0220 Intraoral - periapical first radiographic image D0230 Intraoral - periapical each additional radiographic image D0272 Bitewings - two radiographic images D0273 Bitewings - three radiographic images D0274 Bitewings - four radiographic images D0330 Panoramic radiographic image D0470 Diagnostic casts D1110 Prophylaxis - adult D1120 Prophylaxis - child D1206 Topical fluoride varnish D1208 Topical application of fluoride D1330 Oral hygiene instructions D1351 Sealant - per tooth Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 17

18 2013 Survey of Dental s General Practitioners - New England Division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) Procedure D1510 Space maintainer - fixed - unilateral D1515 Space maintainer - fixed - bilateral Amalgam - one surface, primary or D2140 permanent Amalgam - two surfaces, primary or D2150 permanent Amalgam - three surfaces, primary or D2160 permanent Amalgam - four or more surfaces, primary D2161 or permanent Resin-based composite - one surface, D2330 anterior Resin-based composite - two surfaces, D2331 anterior Resin-based composite - three surfaces, D2332 anterior Resin-based composite - four or more surfaces or involving incisal angle D2335 (anterior) D2390 Resin-based composite crown, anterior Resin-based composite - one surface, D2391 posterior Resin-based composite - two surfaces, D2392 posterior Resin-based composite - three surfaces, D2393 posterior Resin-based composite - four or more D2394 surfaces, posterior D2543 Onlay - metallic - three surfaces 1, ,031 1,260 1,263 1,300 1,300 1, D2643 Onlay - porcelain/ceramic - three surfaces 1, ,028 1,245 1,250 1,282 1,300 1, D2644 Onlay - porcelain/ceramic - four or more surfaces 1, ,000 1,168 1,300 1,360 1,400 1,616 1, D2740 Crown - porcelain/ceramic substrate 1, ,005 1,150 1,269 1,350 1,400 1,500 1,560 1, Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 18

19 Procedure D Survey of Dental s General Practitioners - New England Division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) Crown - porcelain fused to high noble metal 1, ,050 1,132 1,250 1,340 1,395 1,440 1,525 1, Crown - porcelain fused to predominantly base metal 1, ,138 1,300 1,323 1,340 1,400 1, D2751 D2752 Crown - porcelain fused to noble metal 1, ,000 1,084 1,200 1,300 1,325 1,340 1,400 1, D2790 Crown - full cast high noble metal 1, ,011 1,138 1,255 1,350 1,400 1,467 1,560 1, Provisional crown further treatment or completion of diagnosis necessary prior to D2799 final impression D2920 Recement crown Prefabricated stainless steel crown - D2930 primary tooth D2940 Protective restoration D2950 Core buildup, including any pins Post and core in addition to crown; D2952 indirectly fabricated Prefabricated post and core in addition to D2954 crown D2961 Labial veneer (resin laminate) - laboratory ,000 1,138 1,179 1,216 1,400 1, D2962 Labial veneer (porcelain laminate) - laboratory 1, ,017 1,162 1,300 1,340 1,370 1,500 1, D2970 Temporary crown (fractured tooth) D3110 Pulp cap - direct (excluding final restoration) D3120 Pulp cap - indirect (excluding final restoration) D3220 Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament D3221 Pulpal debridement, primary and permanent teeth Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 19

20 Procedure D3310 D3320 D3330 D Survey of Dental s General Practitioners - New England Division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) Endodontic therapy, anterior tooth (excluding final restoration) , Endodontic therapy, bicuspid tooth (excluding final restoration) ,050 1,065 1,096 1,144 1, Endodontic therapy, molar (excluding final restoration) 1, ,050 1,180 1,250 1,295 1,305 1,375 1, Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant Gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quadrant D4211 D4249 Clinical crown lengthening - hard tissue ,025 1,136 1,178 1,230 1, D4321 Provisional splinting - extracoronal Periodontal scaling and root planing - four D4341 or more teeth per quadrant Periodontal scaling and root planing - one D4342 to three teeth per quadrant Full mouth debridement to enable D4355 comprehensive evaluation and diagnosis Localized delivery of antimicrobial agents via a controlled release vehicle into D4381 diseased crevicular tissue, per tooth D4910 Periodontal maintenance D5110 Complete denture - maxillary 1, ,139 1,416 1,676 1,910 1,999 2,005 2,183 2, D5120 Complete denture - mandibular 1, ,200 1,418 1,691 1,973 2,000 2,128 2,200 2, D5130 Immediate denture - maxillary 1, ,112 1,500 1,800 2,048 2,174 2,250 2,325 2, D5140 Immediate denture - mandibular 1, ,112 1,500 1,797 2,024 2,174 2,250 2,325 2, D5211 Maxillary partial denture - resin base (including any conventional clasps, rests, and teeth) 1, ,223 1,475 1,506 1,621 1,746 1, Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 20

21 Procedure D5212 D5213 D5214 D Survey of Dental s General Practitioners - New England Division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) Mandibular partial denture - resin base (including any conventional clasps, rests, and teeth) 1, ,250 1,500 1,512 1,600 1,766 1, Maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests, and teeth) 1, ,225 1,465 1,696 2,000 2,122 2,200 2,325 2, Mandibular partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests, and teeth) 1, ,225 1,468 1,680 2,000 2,122 2,200 2,325 2, Maxillary partial denture - flexible base (including any clasps, rests, and teeth) 1, ,100 1,295 1,506 1,680 1,793 1,900 1,910 2, D5226 Mandibular partial denture - flexible base (including any clasps, rests, and teeth) 1, ,000 1,295 1,522 1,703 1,793 1,850 1,910 2, D5510 Repair broken complete denture base D5520 Replace missing or broken teeth - complete denture (each tooth) D5610 Repair resin denture base D5640 Replace broken teeth - per tooth D5650 Add tooth to existing partial denture D5660 Add clasp to existing partial denture D5710 Rebase complete maxillary denture D5730 Reline complete maxillary denture (chairside) D5731 Reline complete mandibular denture (chairside) D5750 Reline complete maxillary denture (laboratory) D5751 Reline complete mandibular denture (laboratory) D6056 Prefabricated abutment includes modification and placement ,000 1, Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 21

22 Procedure D6057 D6059 D Survey of Dental s General Practitioners - New England Division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) Custom fabricated abutment - includes placement ,000 1,100 1,150 1,200 1, Abutment supported porcelain fused to metal crown (high noble metal) 1, ,240 1,297 1,440 1,600 1,694 1,759 1,903 2, Implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) 1, ,240 1,297 1,442 1,645 1,755 1,815 1,998 2, D6069 Abutment supported retainer for porcelain fused to metal FPD (high noble metal) 1, ,150 1,250 1,388 1,600 1,620 1,699 1,850 1, D6210 Pontic - cast high noble metal 1, ,100 1,205 1,340 1,350 1,466 1,500 1, D6240 Pontic - porcelain fused to high noble metal 1, ,047 1,130 1,234 1,340 1,350 1,450 1,560 1, D6241 Pontic - porcelain fused to predominantly base metal 1, ,053 1,242 1,260 1,300 1,500 1, D6245 Pontic - porcelain/ceramic 1, ,100 1,246 1,340 1,348 1,400 1,470 1, D6545 Retainer - cast metal for resin bonded fixed prosthesis ,200 1, D6750 Crown - porcelain fused to high noble metal 1, ,041 1,129 1,240 1,346 1,398 1,450 1,560 1, D6751 Crown - porcelain fused to predominantly base metal 1, ,100 1,234 1,242 1,269 1,300 1, D6790 Crown - full cast high noble metal 1, ,060 1,115 1,269 1,350 1,400 1,500 1,595 1, D6930 Recement fixed partial denture D7111 Extraction, coronal remnants - deciduous tooth D7140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) D7210 Surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap D7220 Removal of impacted tooth - soft tissue Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 22

23 Procedure D7250 D9110 D Survey of Dental s General Practitioners - New England Division (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) Surgical removal of residual tooth roots (cutting procedure) Palliative (emergency) treatment of dental pain - minor procedure Consultation (diagnostic service provided by dentist or physician other than requesting dentist or physician) Office visit - after regularly scheduled hours D9440 D9910 Application of desensitizing medicament D9940 Occlusal guard, by report D9941 Fabrication of athletic mouthguard D9951 Occlusal adjustment - limited D9952 Occlusal adjustment - complete D9972 External bleaching - per arch - performed in office D9974 Internal bleaching - per tooth D9975 External bleaching for home application, per arch; includes materials and fabrication of custom trays Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 23

24 Procedure D Survey of Dental s General Practitioners - Middle Atlantic Division (New Jersey, New York, Pennsylvania) Periodic oral evaluation established patient D0140 Limited oral evaluation - problem focused D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver D0150 Comprehensive oral evaluation - new or established patient D0160 Detailed and extensive oral evaluation - problem focused, by report D0170 Re-evaluation - limited, problem focused (established patient; not post-operative visit) D0180 Comprehensive periodontal evaluation - new or established patient D0210 Intraoral - complete series of radiographic images D0220 Intraoral - periapical first radiographic image D0230 Intraoral - periapical each additional radiographic image D0272 Bitewings - two radiographic images D0273 Bitewings - three radiographic images D0274 Bitewings - four radiographic images D0277 Vertical bitewings - 7 to 8 radiographic images D0330 Panoramic radiographic image D0350 Oral/facial photographic images D0470 Diagnostic casts D1110 Prophylaxis - adult D1120 Prophylaxis - child D1206 Topical fluoride varnish Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 24

25 2013 Survey of Dental s General Practitioners - Middle Atlantic Division (New Jersey, New York, Pennsylvania) Procedure D1208 Topical application of fluoride Tobacco counseling for the control and D1320 prevention of oral disease D1330 Oral hygiene instructions D1351 Sealant - per tooth Preventive resin restoration in a moderate to high caries risk patient - permanent D1352 tooth D1510 Space maintainer - fixed - unilateral D1515 Space maintainer - fixed - bilateral Amalgam - one surface, primary or D2140 permanent Amalgam - two surfaces, primary or D2150 permanent Amalgam - three surfaces, primary or D2160 permanent Amalgam - four or more surfaces, primary D2161 or permanent Resin-based composite - one surface, D2330 anterior Resin-based composite - two surfaces, D2331 anterior Resin-based composite - three surfaces, D2332 anterior Resin-based composite - four or more surfaces or involving incisal angle D2335 (anterior) D2390 Resin-based composite crown, anterior Resin-based composite - one surface, D2391 posterior Resin-based composite - two surfaces, D2392 posterior Resin-based composite - three surfaces, D2393 posterior Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental s. Copyright 2014 American Dental Association. 25

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