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Careington Dental

Dental Schedule

Dental schedule by state

Choose your state from the selection on the right.

Dental Schedule

Choose your state from the selection above

Schedule of Services

  • 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. Fee schedules are subject to change without prior notification to members.
  • Dental procedure codes not listed on this schedule will be discounted at 20% off the General Dentist's normal fee 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.
  • Discount plans are not insurance
Careington Care 500 Series Schedule - 501
 Diagnostic ServicesMember Pays
D0120Periodic Oral Evaluation - Established Patient$15
D0140Limited Oral Evaluation - Problem Focused$19
D0150Comprehensive Oral Evaluation - New or Established Patient$19
D0210Intraoral - Complete Series of Radiographic Images$43
D0220Intraoral - Periapical First Radiographic Image$11
D0230Intraoral - Periapical Each Additional Radiographic Image$6
D0270Bitewing - Single Radiographic Image$11
D0272Bitewings - Two Radiographic Images$14
D0273Bitewings - Three Radiographic Images$18
D0274Bitewings - Four Radiographic Images$22
D0330Panoramic Radiographic Image$43
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult$31
D1120Prophylaxis - Child$23
D1351Sealant - Per Tooth$22
D1510Space Maintainer - Fixed, Unilateral$94
D1515Space Maintainer - Fixed - Bilateral$137
D1520Space Maintainer - Removable - Unilateral$122
D1525Space Maintainer - Removable - Bilateral$154
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$43
D2150Amalgam - Two Surfaces, Primary or Permanent$55
D2160Amalgam - Three Surfaces, Primary or Permanent$65
D2161Amalgam - Four or More Surfaces, Primary or Permanent$79
D2330Resin - Based Composite - One Surface, Anterior$55
D2331Resin - Based Composite - Two Surfaces, Anterior$66
D2332Resin - Based Composite - Three Surfaces, Anterior$83
D2335Resin - Based Composite - Four or More Surfaces, Anterior$106
D2391Resin - Based Composite - One Surface, Posterior$69
D2392Resin - Based Composite - Two Surfaces, Posterior$102
D2393Resin - Based Composite - Three Surfaces, Posterior$129
D2394Resin - Based Composite - Four or More Surfaces, Posterior$149
D2710Crown - Resin-Based Composite (indirect)$206
D2720Crown- Resin with High Noble Metal$435
D2750Crown - Porcelain Fused to High Noble Metal$511
D2751Crown - Porcelain Fused to Predominantly Base Metal$462
D2752Crown - Porcelain Fused to Noble Metal$483
D2790Crown - Full Cast High Noble Metal$502
D2791Crown - Full Cast Predominantly Base Metal$450
D2930Prefabricated Stainless Steel Crown - Primary Tooth$100
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$114
D2950Core Buildup - Including Any Pins When Required$100
D2951Pin Retention - Per Tooth in Addition to Restoration$25
D2952Post and Core in Addition to Crown, Indirectly Fabricated$158
D2954Prefabricated Post and Core in Addition to Crown$123
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$23
D3120Pulp Cap - Indirect (excluding final restoration)$23
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$55
D3310Endodontic Therapy, Anterior Tooth (excluding final restoration)$294
D3320Endodontic Therapy, Bicuspid Tooth (excluding final restoration)$348
D3330Endodontic Therapy - Molar (excluding final restoration)$438
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$293
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$102
D4910Periodontal Maintenance$65
 Prosthodontics (Removeable) ServicesMember Pays
D5110Complete Denture - Maxillary$643
D5120Complete Denture - Mandibular$643
D5130Immediate Denture - Maxillary$669
D5140Immediate Denture - Mandibular$669
D5211Maxillary Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$630
D5212Mandibular Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$630
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$729
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$729
D5410Adjust Complete Denture - Maxillary$37
D5411Adjust Complete Denture - Mandibular$37
D5510Repair Broken Complete Denture Base$57
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$55
D5630Repair or Replace Broken Clasp$66
D5650Add Tooth to Existing Partial Denture$57
D5660Add Clasp to Existing Partial Denture - Per Tooth$73
D5730Reline Complete Maxillary Denture (chairside)$136
D5731Reline Complete Mandibular Denture (chairside) $136
D5740Reline Maxillary Partial Denture (chairside)$130
D5741Reline Mandibular Partial Denture (chairside)$130
D5750Reline Complete Maxillary Denture (laboratory)$178
D5751Reline Complete Mandibular Denture (laboratory)$178
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$444
D6241Pontic - Porcelain Fused to Predominantly Base Metal$409
D6242Pontic - Porcelain Fused to Noble Metal$427
D6750Retainer Crown - Porcelain Fused to High Noble Metal$489
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$441
D6752Retainer Crown - Porcelain Fused to Noble Metal$458
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$55
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$140
D7220Removal of Impacted Tooth - Soft Tissue$112
D7230Removal of Impacted Tooth - Partially Bony$147
D7240Removal of Impacted Tooth - Completely Bony$212
D7250Removal of Residual Tooth Roots (cutting procedure)$112
D7310Alveoloplasty in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$94
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$135
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$69
 Orthodontic ServicesMember Pays
D8070Comprehensive Orthodontic Treatment of the Transitional Dentition20% Discount
D8080Comprehensive Orthodontic Treatment of the Adolescent Dentition20% Discount
D8090Comprehensive Orthodontic Treatment of the Adult Dentition20% Discount
 Other ServicesMember Pays
D9110Palliative (emergency) Treatment Dental Pain - Minor Procedure$37
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$13
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$26
D9951Occlusal Adjustment - Limited$51
D9952Occlusal Adjustment - Complete$203

Exclusions and Limitations

  • If the General Dentist's normal fee for any dental procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that dental procedure.
  • Any procedure involving lab and OSHA fees will incur additional costs. All applicable lab and OSHA fees are the full responsibility of the member and are subject to no discount.
  • Fees subject to change.
  • 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 Corporation, Attn. Provider Relations, PO Box 2568, Frisco, Texas 75034.
  • It is the Member's responsibility to verify that the dentist is a participating Provider before seeking any treatment. Any dental procedures performed by a non-participating dentist are not discounted and are charged at the dentist's normal fees.
  • The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment - many treatments may require more than one dental procedure. Please consult your Careington provider for a detailed treatment plan prior to beginning any work.
  • Careington can not guarantee the continued participation of any dentist. If the dentist leaves the plan, you will need to select another participating Careington provider. Not all types of dentists may be available in your area.

Schedule of Services

  • 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. Fee schedules are subject to change without prior notification to members.
  • Dental procedure codes not listed on this schedule will be discounted at 20% off the General Dentist's normal fee 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.
  • Discount plans are not insurance
Careington Care 500 Series Schedule - 502
 Diagnostic ServicesMember Pays
D0120Periodic Oral Evaluation - Established Patient$16
D0140Limited Oral Evaluation - Problem Focused$22
D0150Comprehensive Oral Evaluation - New or Established Patient$26
D0210Intraoral - Complete Series of Radiographic Images$50
D0220Intraoral - Periapical First Radiographic Image$12
D0230Intraoral - Periapical Each Additional Radiographic Image$9
D0270Bitewing - Single Radiographic Image$12
D0272Bitewings - Two Radiographic Images$15
D0273Bitewings - Three Radiographic Images$21
D0274Bitewings - Four Radiographic Images$25
D0330Panoramic Radiographic Image$50
 Preventive ServicesMember Pays
D1110Prophylaxis - Adult$37
D1120Prophylaxis - Child$26
D1351Sealant - Per Tooth$25
D1510Space Maintainer - Fixed, Unilateral$106
D1515Space Maintainer - Fixed - Bilateral$154
D1520Space Maintainer - Removable - Unilateral$137
D1525Space Maintainer - Removable - Bilateral$175
CodeRestorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$50
D2150Amalgam - Two Surfaces, Primary or Permanent$62
D2160Amalgam - Three Surfaces, Primary or Permanent$75
D2161Amalgam - Four or More Surfaces, Primary or Permanent$90
D2330Resin - Based Composite - One Surface, Anterior$60
D2331Resin - Based Composite - Two Surfaces, Anterior$75
D2332Resin - Based Composite - Three Surfaces, Anterior$95
D2335Resin - Based Composite - Four or More Surfaces, Anterior$117
D2391Resin - Based Composite - One Surface, Posterior$81
D2392Resin - Based Composite - Two Surfaces, Posterior$119
D2393Resin - Based Composite - Three Surfaces, Posterior$147
D2394Resin - Based Composite - Four or More Surfaces, Posterior$167
D2710Crown - Resin-Based Composite (indirect)$230
D2720Crown- Resin with High Noble Metal$488
D2750Crown - Porcelain Fused to High Noble Metal$578
D2751Crown - Porcelain Fused to Predominantly Base Metal$524
D2752Crown - Porcelain Fused to Noble Metal545
D2790Crown - Full Cast High Noble Metal$569
D2791Crown - Full Cast Predominantly Base Metal$530
D2930Prefabricated Stainless Steel Crown - Primary Tooth$113
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$130
D2950Core Buildup, Including Any Pins when required$113
D2951Pin Retention - Per Tooth, in Addition to Restoration$27
D2952Post and Core in Addition to Crown, Indirectly Fabricated$178
D2954Prefabricated Post and Core in Addition to Crown$139
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$25
D3120Pulp Cap - Indirect (excluding final restoration)$25
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$60
D3310Endodontic Therapy, Anterior Tooth (excluding final restoration)$333
D3320Endodontic Therapy, Bicuspid Tooth (excluding final restoration)$394
D3330Endodontic Therapy, Molar (excluding final restoration)$496
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$338
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$112
D4910Periodontal Maintenance$69
 Prosthodontics (Removeable) ServicesMember Pays
D5110Complete Denture - Maxillary$726
D5120Complete Denture - Mandibular$726
D5130Immediate Denture - Maxillary$757
D5140Immediate Denture - Mandibular$757
D5211Maxillary Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$662
D5212Mandibular Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$662
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$823
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$823
D5410Adjust Complete Denture - Maxillary$38
D5411Adjust Complete Denture - Mandibular$38
D5510Repair Broken Complete Denture Base$65
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$60
D5630Repair or Replace Broken Clasp - Per Tooth$75
D5650Add Tooth to Existing Partial Denture$65
D5660Add Clasp to Existing Partial Denture - Per Tooth$83
D5730Reline Complete Maxillary Denture (chairside)$153
D5731Reline Complete Mandibular Denture (chairside)$153
D5740Reline Maxillary Partial Denture (chairside)$147
D5741Reline Mandibular Partial Denture (chairside)$147
D5750Reline Complete Maxillary Denture (laboratory)$201
D5751Reline Complete Mandibular Denture (laboratory)$201
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$498
D6241Pontic - Porcelain Fused to Predominantly Base Metal$462
D6242Pontic - Porcelain Fused to Noble Metal$483
D6750Retainer Crown - Porcelain Fused to High Noble Metal$553
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$498
D6752Retainer Crown - Porcelain Fused to Noble Metal$516
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$60
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$151
D7220Removal of Impacted Tooth - Soft Tissue$126
D7230Removal of Impacted Tooth - Partially Bony$165
D7240Removal of Impacted Tooth - Completely Bony$231
D7250Removal of Residual Tooth Roots (cutting procedure)$127
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$106
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$152
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$78
 Orthodontic ServicesMember Pays
D8070Comprehensive Orthodontic Treatment of the Transitional Dentition20% Discount
D8080Comprehensive Orthodontic Treatment of the Adolescent Dentition20% Discount
D8090Comprehensive Orthodontic Treatment of the Adult Dentition20% Discount
 Other ServicesMember Pays
D9110Palliative (emergency) Treatment of Dental Pain - Minor Procedure$40
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$15
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$27
D9951Occlusal Adjustment - Limited$57
D9952Occlusal Adjustment - Complete$228

Exclusions and Limitations

  • If the General Dentist's normal fee for any dental procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that dental procedure.
  • Any procedure involving lab and OSHA fees will incur additional costs. All applicable lab and OSHA fees are the full responsibility of the member and are subject to no discount.
  • Fees subject to change.
  • 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 Corporation, Attn. Provider Relations, PO Box 2568, Frisco, Texas 75034.
  • It is the Member's responsibility to verify that the dentist is a participating Provider before seeking any treatment. Any dental procedures performed by a non-participating dentist are not discounted and are charged at the dentist's normal fees.
  • The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment - many treatments may require more than one dental procedure. Please consult your Careington provider for a detailed treatment plan prior to beginning any work.
  • Careington can not guarantee the continued participation of any dentist. If the dentist leaves the plan, you will need to select another participating Careington provider. Not all types of dentists may be available in your area.

Schedule of Services

  • 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. Fee schedules are subject to change without prior notification to members.
  • Dental procedure codes not listed on this schedule will be discounted at 20% off the General Dentist's normal fee 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.
  • Discount plans are not insurance
Careington Care 500 Series Schedule - 503
 Diagnostic ServicesMember Pays
D0120Periodic Oral Evaluation - Established Patient$17
D0140Limited Oral Evaluation - Problem Focused$19
D0150Comprehensive Oral Evaluation - New or Established Patient$22
D0210Intraoral - Complete Series of Radiographic Images$52
D0220Intraoral - Periapical First Radiographic Image$12
D0230Intraoral - Periapical Each Additional Radiographic Image$8
D0270Bitewing - Single Radiographic Image$12
D0272Bitewings - Two Radiographic Images$16
D0273Bitewings - Three Radiographic Images$22
D0274Bitewings - Four Radiographic Images$26
D0330Panoramic Radiographic Image$52
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult $38
D1120Prophylaxis - Child $31
D1351Sealant - Per Tooth$26
D1510Space Maintainer - Fixed - Unilateral$112
D1515Space Maintainer - Fixed - Bilateral$165
D1520Space Maintainer - Removable - Unilateral$147
D1525Space Maintainer - Removable - Bilateral$188
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$52
D2150Amalgam - Two Surfaces, Primary or Permanent$66
D2160Amalgam - Three Surfaces, Primary or Permanent$78
D2161Amalgam - Four or More Surfaces, Primary or Permanent$95
D2330Resin - Based Composite - One Surface, Anterior$66
D2331Resin - Based Composite - Two Surfaces, Anterior$79
D2332Resin - Based Composite - Three Surfaces, Anterior$100
D2335Resin - Based Composite - Four or More Surfaces, Anterior$126
D2391Resin - Based Composite - One Surface, Posterior$83
D2392Resin - Based Composite - Two Surfaces, Posterior$119
D2393Resin - Based Composite - Three Surfaces, Posterior$150
D2394Resin - Based Composite - Four or More Surfaces, Posterior$173
D2710Crown - Resin-Based Composite (indirect)$246
D2720Crown- Resin with High Noble Metal$522
D2750Crown - Porcelain Fused to High Noble Metal$618
D2751Crown - Porcelain Fused to Predominantly Base Metal$562
D2752Crown - Porcelain Fused to Noble Metal$603
D2790Crown - Full Cast High Noble Metal$605
D2791Crown - Full Cast Predominantly Base Metal$562
D2930Prefabricated Stainless Steel Crown - Primary Tooth$121
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$137
D2950Core Buildup - Including Any Pins When Required$121
D2951Pin Retention - Per Tooth in Addition to Restoration$29
D2952Post and Core in Addition to Crown, Indirectly Fabricated$190
D2954Prefabricated Post and Core in Addition to Crown$148
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$27
D3120Pulp Cap - Indirect (excluding final restoration)$27
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$66
D3310Endodontic Therapy - Anterior Tooth (excluding final restoration)$352
D3320Endodontic Therapy - Bicuspid Tooth (excluding final restoration)$419
D3330Endodontic Thearpy - Molar (excluding final restoration)$526
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$351
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$125
D4910Periodontal Maintenance$75
 Prosthodontics (Removable) ServicesMember Pays
D5110Complete Denture - Maxillary$758
D5120Complete Denture - Mandibular$758
D5130Immediate Denture - Maxillary$787
D5140Immediate Denture - Mandibular$787
D5211Maxillary Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$740
D5212Mandibular Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$740
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$860
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$860
D5410Adjust Complete Denture - Maxillary$43
D5411Adjust Complete Denture - Mandibular$43
D5510Repair Broken Complete Denture Base$69
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$66
D5630Repair or Replace Broken Clasp - Per Tooth$79
D5650Add Tooth to Existing Partial Denture$69
D5660Add Clasp to Existing Partial Denture - Per Tooth$87
D5730Reline Complete Maxillary Denture (chairside)$164
D5731Reline Complete Mandibular Denture (chairside)$164
D5740Reline Maxillary Partial Denture (chairside)$154
D5741Reline Mandibular Partial Dent (chairside)$154
D5750Reline Complete Maxillary Denture (laboratory)$213
D5751Reline Complete Mandibular Denture (laboratory)$213
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$530
D6241Pontic - Porcelain Fused to Predominantly Base Metal$490
D6242Pontic - Porcelain Fused to Noble Metal$512
D6750Retainer Crown - Porcelain Fused to High Noble Metal$580
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$528
D6752Retainer Crown - Porcelain Fused to Noble Metal$550
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$66
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$160
D7220Removal of Impacted Tooth - Soft Tissue$135
D7230Removal of Impacted Tooth - Partially Bony$175
D7240Removal of Impacted Tooth - Completely Bony$246
D7250Removal of Residual Tooth Roots (cutting procedure)$127
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$112
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$163
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$83
 Orthodontic ServicesMember Pays
D8070Comprehensive Orthodontic Treatment of the Transitional Dentition20% Discount
D8080Comprehensive Orthodontic Treatment of the Adolescent Dentition20% Discount
D8090Comprehensive Orthodontic Treatment of the Adult Dentition20% Discount
 Other ServicesMember Pays
D9110Palliative (emergency) Treatment Dental Pain - Minor Procedure$43
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$16
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$29
D9951Occlusal Adjustment - Limited$59
D9952Occlusal Adjustment - Complete$242

Exclusions and Limitations

  • If the General Dentist's normal fee for any dental procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that dental procedure.
  • Any procedure involving lab and OSHA fees will incur additional costs. All applicable lab and OSHA fees are the full responsibility of the member and are subject to no discount.
  • Fees subject to change.
  • 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 Corporation, Attn. Provider Relations, PO Box 2568, Frisco, Texas 75034.
  • It is the Member's responsibility to verify that the dentist is a participating Provider before seeking any treatment. Any dental procedures performed by a non-participating dentist are not discounted and are charged at the dentist's normal fees.
  • The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment - many treatments may require more than one dental procedure. Please consult your Careington provider for a detailed treatment plan prior to beginning any work.
  • Careington can not guarantee the continued participation of any dentist. If the dentist leaves the plan, you will need to select another participating Careington provider. Not all types of dentists may be available in your area.

Schedule of Services

  • 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. Fee schedules are subject to change without prior notification to members.
  • Dental procedure codes not listed on this schedule will be discounted at 20% off the General Dentist's normal fee 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.
  • Discount plans are not insurance
Careington Care 500 Series Schedule - 504
 Diagnostic ServicesMember Pays
D0120Periodic Oral Evaluation - Established Patient$18
D0140Limited Oral Evaluation - Problem Focused$23
D0150Comprehensive Oral Evaluation - New or Established Patient$23
D0210Intraoral - Complete Series of Radiographic Images$57
D0220Intraoral - Periapical First Radiographic Image$13
D0230Intraoral - Periapical Each Additional Radiographic Image$8
D0270Bitewing - Single Radiographic Image$13
D0272Bitewings - Two Radiographic Images$17
D0273Bitewings - Three Radiographic Images$23
D0274Bitewings - Four Radiographic Images$29
D0330Panoramic Radiographic Image$57
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult $41
D1120Prophylaxis - Child $36
D1351Sealant - Per Tooth$27
D1510Space Maintainer - Fixed, Unilateral$123
D1515Space Maintainer - Fixed - Bilateral$184
D1520Space Maintainer - Removable - Unilateral$163
D1525Space Maintainer - Removable - Bilateral$207
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$57
D2150Amalgam - Two Surfaces, Primary or Permanent$73
D2160Amalgam - Three Surfaces, Primary or Permanent$86
D2161Amalgam - Four or More Surfaces, Primary or Permanent$106
D2330Resin - Based Composite - One Surface, Anterior$73
D2331Resin - Based Composite - Two Surfaces, Anterior$87
D2332Resin - Based Composite - Three Surfaces or$111
D2335Resin - Based Composite - Four or More Surfaces, Anterior$139
D2391Resin - Based Composite - One Surface, Posterior$93
D2392Resin - Based Composite - Two Surfaces, Posterior$134
D2393Resin - Based Composite - Three Surfaces, Posterior$172
D2394Resin - Based Composite - Four or More Surfaces, Posterior$198
D2710Crown - Resin-Based Composite (indirect)$259
D2720Crown- Resin with High Noble Metal$549
D2750Crown - Porcelain Fused to High Noble Metal$643
D2751Crown - Porcelain Fused to Predominantly Base Metal$585
D2752Crown - Porcelain Fused to Noble Metal$624
D2790Crown - Full Cast High Noble Metal$630
D2791Crown - Full Cast Predominantly Base Metal$593
D2930Prefabricated Stainless Steel Crown - Primary Tooth$134
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$152
D2950Core Buildup - Including Any Pins when required$134
D2951Pin Retention - Per Tooth, in Addition to Restoration$30
D2952Post and Core in Addition to Crown, Indirectly Fabricated$210
D2954Prefabricated Post and Core in Addition to Crown$164
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$30
D3120Pulp Cap - Indirect (excluding final restoration)$30
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$73
D3310Endodontic Therapy - Anterior Tooth (excluding final restoration)$366
D3320Endodontic Therapy - Bicuspid Tooth (excluding final restoration)$440
D3330Endodontic Thearpy - Molar (excluding final restoration)$557
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$387
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$127
D4910Periodontal Maintenance$81
 Prosthodontics (Removable) ServicesMember Pays
D5110Complete Denture - Maxillary$811
D5120Complete Denture - Mandibular$811
D5130Immediate Denture - Maxillary$873
D5140Immediate Denture - Mandibular$873
D5211Maxillary Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$794
D5212Mandibular Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$794
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$924
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$924
D5410Adjust Complete Denture - Maxillary$44
D5411Adjust Complete Denture - Mandibular$44
D5510Repair Broken Complete Denture Base$76
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$73
D5630Repair or Replace Broken Clasp$87
D5650Add Tooth to Existing Partial Denture$76
D5660Add Clasp to Existing Partial Denture - Per Tooth$97
D5730Reline Complete Maxillary Denture (chairside)$180
D5731Reline Complete Mandibular Denture (chairside)$180
D5740Reline Maxillary Partial Denture (chairside)$172
D5741Reline Mandibular Partial Dent (chairside)$172
D5750Reline Complete Maxillary Denture (laboratory)$237
D5751Reline Complete Mandibular Denture (laboratory)$237
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$581
D6241Pontic - Porcelain Fused to Predominantly Base Metal$536
D6242Pontic - Porcelain Fused to Noble Metal$557
D6750Retainer Crown - Porcelain Fused to High Noble Metal$606
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$562
D6752Retainer Crown - Porcelain Fused to Noble Metal$584
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$73
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$170
D7220Removal of Impacted Tooth - Soft Tissue$150
D7230Removal of Impacted Tooth - Partially Bony$194
D7240Removal of Impacted Tooth - Completely Bony$253
D7250Removal of Residual Tooth Roots (cutting procedure)$135
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$123
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$179
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$93
 Orthodontic ServicesMember Pays
D8070Comprehensive Orthodontic Treatment of the Transitional Dentition20% Discount
D8080Comprehensive Orthodontic Treatment of the Adolescent Dentition20% Discount
D8090Comprehensive Orthodontic Treatment of the Adult Dentition20% Discount
 Other ServicesMember Pays
D9110Palliative (emergency) Treatment Dental Pain - Minor Procedure$46
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$17
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$31
D9951Occlusal Adjustment - Limited$68
D9952Occlusal Adjustment - Complete$269

Exclusions and Limitations

  • If the General Dentist's normal fee for any dental procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that dental procedure.
  • Any procedure involving lab and OSHA fees will incur additional costs. All applicable lab and OSHA fees are the full responsibility of the member and are subject to no discount.
  • Fees subject to change.
  • 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 Corporation, Attn. Provider Relations, PO Box 2568, Frisco, Texas 75034.
  • It is the Member's responsibility to verify that the dentist is a participating Provider before seeking any treatment. Any dental procedures performed by a non-participating dentist are not discounted and are charged at the dentist's normal fees.
  • The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment - many treatments may require more than one dental procedure. Please consult your Careington provider for a detailed treatment plan prior to beginning any work.
  • Careington can not guarantee the continued participation of any dentist. If the dentist leaves the plan, you will need to select another participating Careington provider. Not all types of dentists may be available in your area.

Schedule of Services

  • 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. Fee schedules are subject to change without prior notification to members.
  • Dental procedure codes not listed on this schedule will be discounted at 20% off the General Dentist's normal fee 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.
  • Discount plans are not insurance
Careington Care 500 Series Schedule - 505
 Diagnostic ServicesMember Pays
D0120Periodic Oral Evaluation - Established Patient$19
D0140Limited Oral Evaluation - Problem Focused$25
D0150Comprehensive Oral Evaluation - New or Established Patient$25
D0210Intraoral - Complete Series of Radiographic Images$59
D0220Intraoral - Periapical First Radiographic Image$14
D0230Intraoral - Periapical Each Additional Radiographic Image$8
D0270Bitewing - Single Radiographic Image$15
D0272Bitewings - Two Radiographic Images$18
D0273Bitewings - Three Radiographic Images$24
D0274Bitewings - Four Radiographic Images$30
D0330Panoramic Radiographic Image$59
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult $44
D1120Prophylaxis - Child $37
D1351Sealant - Per Tooth$29
D1510Space Maintainer - Fixed, Unilateral$131
D1515Space Maintainer - Fixed - Bilateral$192
D1520Space Maintainer - Removable - Unilateral$171
D1525Space Maintainer - Removable - Bilateral$217
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$59
D2150Amalgam - Two Surfaces, Primary or Permanent$76
D2160Amalgam - Three Surfaces, Primary or Permanent$90
D2161Amalgam - Four or More Surfaces, Primary or Permanent$111
D2330Resin - Based Composite - One Surface, Anterior$76
D2331Resin - Based Composite - Two Surfaces, Anterior$93
D2332Resin - Based Composite - Three Surfaces, Anterior$116
D2335Resin - Based Composite - Four or More Surfaces, Anterior$147
D2391Resin - Based Composite - One Surface, Posterior$100
D2392Resin - Based Composite - Two Surfaces, Posterior$144
D2393Resin - Based Composite - Three Surfaces, Posterior$191
D2394Resin - Based Composite - Four or More Surfaces, Posterior$220
D2710Crown - Resin-Based Composite (indirect)$280
D2720Crown- Resin with High Noble Metal$592
D2750Crown - Porcelain Fused to High Noble Metal$687
D2751Crown - Porcelain Fused to Predominantly Base Metal$619
D2752Crown - Porcelain Fused to Noble Metal$654
D2790Crown - Full Cast High Noble Metal$662
D2791Crown - Full Cast Predominantly Base Metal$630
D2930Prefabricated Stainless Steel Crown - Primary Tooth$140
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$161
D2950Core Buildup, Including Any Pins When Required$140
D2951Pin Retention - Per Tooth, in Addition to Restoration$32
D2952Post and Core in Addition to Crown, Indirectly Fabricated$221
D2954Prefabricated Post and Core in Addition to Crown$172
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$31
D3120Pulp Cap - Indirect (excluding final restoration)$31
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$76
D3310Endodontic Therapy, Anterior Tooth (excluding final restoration)$413
D3320Endodontic Therapy, Bicuspid Tooth (excluding final restoration)$488
D3330Endodontic Therapy, Molar (excluding final restoration)$612
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$413
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$137
D4910Periodontal Maintenance $87
 Prosthodontics (Removable) ServicesMember Pays
D5110Complete Denture - Maxillary$892
D5120Complete Denture - Mandibular$892
D5130Immediate Denture - Maxillary$948
D5140Immediate Denture - Mandibular$948
D5211Maxillary Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$875
D5212Mandibular Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$875
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$996
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$996
D5410Adjust Complete Denture - Maxillary$46
D5411Adjust Complete Denture - Mandibular$46
D5510Repair Broken Complete Denture Base$80
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$76
D5630Repair or Replace Broken Clasp - Per Tooth$93
D5650Add Tooth to Existing Partial Denture$80
D5660Add Clasp to Existing Partial Denture - Per Tooth$102
D5730Reline Complete Maxillary Denture (chairside)$191
D5731Reline Complete Mandibular Denture (chairside)$191
D5740Reline Maxillary Partial Denture (chairside)$180
D5741Reline Mandibular Partial Denture (chairside)$180
D5750Reline Complete Maxillary Denture (laboratory)$249
D5751Reline Complete Mandibular Denture (laboratory)$249
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$673
D6241Pontic - Porcelain Fused to Predominantly Base Metal$564
D6242Pontic - Porcelain Fused to Noble Metal$610
D6750Retainer Crown - Porcelain Fused to High Noble Metal$643
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$597
D6752Retainer Crown - Porcelain Fused to Noble Metal$611
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$76
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$175
D7220Removal of Impacted Tooth - Soft Tissue$156
D7230Removal of Impacted Tooth - Partially Bony$205
D7240Removal of Impacted Tooth - Completely Bony$273
D7250Removal of Residual Tooth Roots (cutting procedure)$144
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$131
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$190
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$96
 Orthodontic ServicesMember Pays
D8070Comprehensive Orthodontic Treatment of the Transitional Dentition20% Discount
D8080Comprehensive Orthodontic Treatment of the Adolescent Dentition20% Discount
D8090Comprehensive Orthodontic Treatment of the Adult Dentition20% Discount
 Other ServicesMember Pays
D9110Palliative (emergency) Treatment Dental Pain - Minor Procedure$51
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$18
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$31
D9951Occlusal Adjustment - Limited$70
D9952Occlusal Adjustment - Complete$283

Exclusions and Limitations

  • If the General Dentist's normal fee for any dental procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that dental procedure.
  • Any procedure involving lab and OSHA fees will incur additional costs. All applicable lab and OSHA fees are the full responsibility of the member and are subject to no discount.
  • Fees subject to change.
  • 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 Corporation, Attn. Provider Relations, PO Box 2568, Frisco, Texas 75034.
  • It is the Member's responsibility to verify that the dentist is a participating Provider before seeking any treatment. Any dental procedures performed by a non-participating dentist are not discounted and are charged at the dentist's normal fees.
  • The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment - many treatments may require more than one dental procedure. Please consult your Careington provider for a detailed treatment plan prior to beginning any work.
  • Careington can not guarantee the continued participation of any dentist. If the dentist leaves the plan, you will need to select another participating Careington provider. Not all types of dentists may be available in your area.

Schedule of Services

  • 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. Fee schedules are subject to change without prior notification to members.
  • Dental procedure codes not listed on this schedule will be discounted at 20% off the General Dentist's normal fee 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.
  • Discount plans are not insurance
Careington Care 500 Series Schedule - 506
 Diagnostic ServicesMember Pays
D0120Periodic Oral Evaluation - Established Patient$23
D0140Limited Oral Evaluation - Problem Focused$27
D0150Comprehensive Oral Evaluation - New or Established Patient$33
D0210Intraoral - Complete Series of Radiographic Images$69
D0220Intraoral - Periapical First Radiographic Image$16
D0230Intraoral - Periapical Each Additional Radiographic Image$10
D0270Bitewing - Single Radiographic Image$16
D0272Bitewings - Two Radiographic Images$19
D0273Bitewings - Three Radiographic Images$25
D0274Bitewings - Four Radiographic Images$30
D0330Panoramic Radiographic Image$69
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult $51
D1120Prophylaxis - Child $41
D1351Sealant - Per Tooth$36
D1510Space Maintainer - Fixed, Unilateral$150
D1515Space Maintainer - Fixed - Bilateral$221
D1520Space Maintainer - Removable - Unilateral$194
D1525Space Maintainer - Removable - Bilateral$248
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$69
D2150Amalgam - Two Surfaces, Primary or Permanent$87
D2160Amalgam - Three Surfaces, Primary or Permanent$103
D2161Amalgam - Four or More Surfaces, Primary or Permanent$126
D2330Resin - Based Composite - One Surface, Anterior$87
D2331Resin - Based Composite - Two Surfaces, Anterior$107
D2332Resin - Based Composite - Three Surfaces, Anterior$134
D2335Resin - Based Composite - Four or More Surfaces, Anterior$168
D2391Resin - Based Composite - One Surface, Posterior$112
D2392Resin - Based Composite - Two Surfaces, Posterior$164
D2393Resin - Based Composite - Three Surfaces, Posterior$207
D2394Resin - Based Composite - Four or More Surfaces, Posterior$237
D2710Crown - Resin-Based Composite (indirect)$307
D2720Crown- Resin with High Noble Metal$651
D2750Crown - Porcelain Fused to High Noble Metal$767
D2751Crown - Porcelain Fused to Predominantly Base Metal$748
D2752Crown - Porcelain Fused to Noble Metal$759
D2790Crown - Full Cast High Noble Metal$784
D2791Crown - Full Cast Predominantly Base Metal$743
D2930Prefabricated Stainless Steel Crown - Primary Tooth$153
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$172
D2950Core Buildup - Including Any Pins When Required$150
D2951Pin Retention - Per Tooth, in Addition to Restoration$38
D2952Post and Core in Addition to Crown, Indirectly Fabricated$248
D2954Prefabricated Post and Core in Addition to Crown$188
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$38
D3120Pulp Cap - Indirect (excluding final restoration)$36
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$87
D3310Endodontic Therapy - Anterior Tooth (excluding final restoration)$471
D3320Endodontic Therapy - Bicuspid Tooth (excluding final restoration)$557
D3330Endodontic Thearpy - Molar (excluding final restoration)$700
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$485
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$158
D4910Periodontal Maintenance$98
 Prosthodontics (Removable) ServicesMember Pays
D5110Complete Denture - Maxillary$1,016
D5120Complete Denture - Mandibular$1,016
D5130Immediate Denture - Maxillary$1,070
D5140Immediate Denture - Mandibular$1,070
D5211Maxillary Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$999
D5212Mandibular Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$999
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$1,142
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$1,142
D5410Adjust Complete Denture - Maxillary$54
D5411Adjust Complete Denture - Mandibular$54
D5510Repair Broken Complete Denture Base$93
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$87
D5630Repair or Replace Broken Clasp - Per Tooth$107
D5650Add Tooth to Existing Partial Denture$93
D5660Add Clasp to Existing Partial Denture - Per Tooth$117
D5730Reline Complete Maxillary Denture (chairside)$212
D5731Reline Complete Mandibular Denture (chairside)$212
D5740Reline Maxillary Partial Denture (chairside)$199
D5741Reline Mandibular Partial Dent (chairside)$199
D5750Reline Complete Maxillary Denture (laboratory)$274
D5751Reline Complete Mandibular Denture (laboratory)$274
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$703
D6241Pontic - Porcelain Fused to Predominantly Base Metal$649
D6242Pontic - Porcelain Fused to Noble Metal$669
D6750Retainer Crown - Porcelain Fused to High Noble Metal$748
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$705
D6752Retainer Crown - Porcelain Fused to Noble Metal$732
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$87
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$183
D7220Removal of Impacted Tooth - Soft Tissue$179
D7230Removal of Impacted Tooth - Partially Bony$233
D7240Removal of Impacted Tooth - Completely Bony$306
D7250Removal of Residual Tooth Roots (cutting procedure)$168
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$150
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$216
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$111
 Orthodontic ServicesMember Pays
D8070Comprehensive Orthodontic Treatment of the Transitional Dentition20% Discount
D8080Comprehensive Orthodontic Treatment of the Adolescent Dentition20% Discount
D8090Comprehensive Orthodontic Treatment of the Adult Dentition20% Discount
 Other ServicesMember Pays
D9110Palliative (emergency) Treatment Dental Pain - Minor Procedure$57
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$23
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$38
D9951Occlusal Adjustment - Limited$80
D9952Occlusal Adjustment - Complete$324

Exclusions and Limitations

  • If the General Dentist's normal fee for any dental procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that dental procedure.
  • Any procedure involving lab and OSHA fees will incur additional costs. All applicable lab and OSHA fees are the full responsibility of the member and are subject to no discount.
  • Fees subject to change.
  • 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 Corporation, Attn. Provider Relations, PO Box 2568, Frisco, Texas 75034.
  • It is the Member's responsibility to verify that the dentist is a participating Provider before seeking any treatment. Any dental procedures performed by a non-participating dentist are not discounted and are charged at the dentist's normal fees.
  • The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment - many treatments may require more than one dental procedure. Please consult your Careington provider for a detailed treatment plan prior to beginning any work.
  • Careington can not guarantee the continued participation of any dentist. If the dentist leaves the plan, you will need to select another participating Careington provider. Not all types of dentists may be available in your area.

Schedule of Services

  • 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. Fee schedules are subject to change without prior notification to members.
  • Dental procedure codes not listed on this schedule will be discounted at 20% off the General Dentist's normal fee 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.
  • Discount plans are not insurance
Careington Care 500 Series Schedule - 507
 Diagnostic ServicesMember Pays
D0120Periodic Oral Evaluation - Established Patient$24
D0140Limited Oral Evaluation - Problem Focused$36
D0150Comprehensive Oral Evaluation - New or Established Patient$40
D0210Intraoral - Complete Series of Radiographic Images$69
D0220Intraoral - Periapical First Radiographic Image$14
D0230Intraoral - Periapical Each Additional Radiographic Image$12
D0270Bitewing - Single Radiographic Image$13
D0272Bitewings - Two Radiographic Images$18
D0273Bitewings - Three Radiographic Images$23
D0274Bitewings - Four Radiographic Images$27
D0330Panoramic Radiographic Image$58
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult $45
D1120Prophylaxis - Child $36
D1351Sealant - Per Tooth$27
D1510Space Maintainer - Fixed, Unilateral$172
D1515Space Maintainer - Fixed - Bilateral$245
D1520Space Maintainer - Removable - Unilateral$205
D1525Space Maintainer - Removable - Bilateral$255
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$57
D2150Amalgam - Two Surfaces, Primary or Permanent$76
D2160Amalgam - Three Surfaces, Primary or Permanent$92
D2161Amalgam - Four or More Surfaces, Primary or Permanent$112
D2330Resin - Based Composite - One Surface, Anterior$71
D2331Resin - Based Composite - Two Surfaces, Anterior$90
D2332Resin - Based Composite - Three Surfaces, Anterior$116
D2335Resin - Based Composite - Four or More Surfaces, Anterior$144
D2391Resin - Based Composite - One Surface, Posterior$80
D2392Resin - Based Composite - Two Surfaces, Posterior$112
D2393Resin - Based Composite - Three Surfaces, Posterior$144
D2394Resin - Based Composite - Four or More Surfaces, Posterior$170
D2710Crown - Resin-Based Composite (indirect)$245
D2720Crown- Resin with High Noble Metal$521
D2750Crown - Porcelain Fused to High Noble Metal$612
D2751Crown - Porcelain Fused to Predominantly Base Metal$550
D2752Crown - Porcelain Fused to Noble Metal$573
D2790Crown - Full Cast High Noble Metal$593
D2791Crown - Full Cast Predominantly Base Metal$517
D2930Prefabricated Stainless Steel Crown - Primary Tooth$138
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$160
D2950Core Buildup - Including Any Pins When Required$139
D2951Pin Retention - Per Tooth, in Addition to Restoration$30
D2952Post and Core in Addition to Crown, Indirectly Fabricated$218
D2954Prefabricated Post and Core in Addition to Crown$172
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$37
D3120Pulp Cap - Indirect (excluding final restoration)$37
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$87
D3310Endodontic Therapy, Anterior Tooth (excluding final restoration)$349
D3320Endodontic Therapy, Bicuspid Tooth (excluding final restoration)$419
D3330Endodontic Therapy - Molar (excluding final restoration)$528
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$330
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$122
D4910Periodontal Maintenance$71
 Prosthodontics (Removable) ServicesMember Pays
D5110Complete Denture - Maxillary$788
D5120Complete Denture - Mandibular$788
D5130Immediate Denture - Maxillary$831
D5140Immediate Denture - Mandibular$836
D5211Maxillary Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$592
D5212Mandibular Partial Denture - Resin Base (including any conventional clasps, rests and teeth)$592
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$848
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$852
D5410Adjust Complete Denture - Maxillary$42
D5411Adjust Complete Denture - Mandibular$42
D5510Repair Broken Complete Denture Base$95
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$86
D5630Repair or Replace Broken Clasp - Per Tooth$122
D5650Add Tooth to Existing Partial Denture$106
D5660Add Clasp to Existing Partial Denture - Per Tooth$129
D5730Reline Complete Maxillary Denture (chairside)$179
D5731Reline Complete Mandibular Denture (chairside)$179
D5740Reline Maxillary Partial Denture (chairside)$167
D5741Reline Mandibular Partial Denture (chairside)$167
D5750Reline Complete Maxillary Denture (laboratory)$241
D5751Reline Complete Mandibular Denture (laboratory)$238
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$592
D6241Pontic - Porcelain Fused to Predominantly Base Metal$552
D6242Pontic - Porcelain Fused to Noble Metal$568
D6750Retainer Crown - Porcelain Fused to High Noble Metal$611
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$552
D6752Retainer Crown - Porcelain Fused to Noble Metal$571
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$73
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$183
D7220Removal of Impacted Tooth - Soft Tissue$163
D7230Removal of Impacted Tooth - Partially Bony$206
D7240Removal of Impacted Tooth - Completely Bony$254
D7250Removal of Residual Tooth Roots (cutting procedure)$150
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$148
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$207
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$97
 Orthodontic ServicesMember Pays
D8070Comprehensive Orthodontic Treatment of the Transitional Dentition20% Discount
D8080Comprehensive Orthodontic Treatment of the Adolescent Dentition20% Discount
D8090Comprehensive Orthodontic Treatment of the Adult Dentition20% Discount
 Other ServicesMember Pays
D9110Palliative (emergency) Treatment Dental Pain - Minor Procedure$53
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$23
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$31
D9951Occlusal Adjustment - Limited$81
D9952Occlusal Adjustment - Complete$330

Exclusions and Limitations

  • If the General Dentist's normal fee for any dental procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that dental procedure.
  • Any procedure involving lab and OSHA fees will incur additional costs. All applicable lab and OSHA fees are the full responsibility of the member and are subject to no discount.
  • Fees subject to change.
  • 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 Corporation, Attn. Provider Relations, PO Box 2568, Frisco, Texas 75034.
  • It is the Member's responsibility to verify that the dentist is a participating Provider before seeking any treatment. Any dental procedures performed by a non-participating dentist are not discounted and are charged at the dentist's normal fees.
  • The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment - many treatments may require more than one dental procedure. Please consult your Careington provider for a detailed treatment plan prior to beginning any work.
  • Careington can not guarantee the continued participation of any dentist. If the dentist leaves the plan, you will need to select another participating Careington provider. Not all types of dentists may be available in your area.

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