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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$16
D0140Limited Oral Evaluation - Problem Focused$21
D0150Comprehensive Oral Evaluation - New or Established Patient$21
D0210Intraoral - Complete Series of Radiographic Images$47
D0220Intraoral - Periapical First Radiographic Image$12
D0230Intraoral - Periapical Each Additional Radiographic Image$7
D0270Bitewing - Single Radiographic Image$12
D0272Bitewings - Two Radiographic Images$15
D0273Bitewings - Three Radiographic Images$20
D0274Bitewings - Four Radiographic Images$24
D0330Panoramic Radiographic Image$47
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult$34
D1120Prophylaxis - Child$25
D1351Sealant - Per Tooth$24
D1510Space Maintainer - Fixed, Unilateral$102
D1516Space Maintainer - Fixed - Bilateral, Maxillary20% Discount
D1520Space Maintainer - Removable - Unilateral$133
D1526Space Maintainer - Removable - Bilateral, Maxillary20% Discount
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$47
D2150Amalgam - Two Surfaces, Primary or Permanent$60
D2160Amalgam - Three Surfaces, Primary or Permanent$71
D2161Amalgam - Four or More Surfaces, Primary or Permanent$86
D2330Resin - Based Composite - One Surface, Anterior$60
D2331Resin - Based Composite - Two Surfaces, Anterior$72
D2332Resin - Based Composite - Three Surfaces, Anterior$90
D2335Resin - Based Composite - Four or More Surfaces or Involving Incisal Angle (Anterior)$116
D2391Resin - Based Composite - One Surface, Posterior$75
D2392Resin - Based Composite - Two Surfaces, Posterior$111
D2393Resin - Based Composite - Three Surfaces, Posterior$141
D2394Resin - Based Composite - Four or More Surfaces, Posterior$162
D2710Crown - Resin-Based Composite (indirect)$225
D2720Crown- Resin with High Noble Metal$474
D2750Crown - Porcelain Fused to High Noble Metal$557
D2751Crown - Porcelain Fused to Predominantly Base Metal$504
D2752Crown - Porcelain Fused to Noble Metal$526
D2790Crown - Full Cast High Noble Metal$547
D2791Crown - Full Cast Predominantly Base Metal$491
D2930Prefabricated Stainless Steel Crown - Primary Tooth$109
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$124
D2950Core Buildup - Including Any Pins When Required$109
D2951Pin Retention - Per Tooth in Addition to Restoration$27
D2952Post and Core in Addition to Crown, Indirectly Fabricated$172
D2954Prefabricated Post and Core in Addition to Crown$134
 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)$320
D3320Endodontic Therapy, Premolar Tooth (excluding final restorations)$379
D3330Endodontic Therapy - Molar Tooth (excluding final restorations)$477
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$319
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$111
D4910Periodontal Maintenance$71
 Prosthodontics (Removeable) ServicesMember Pays
D5110Complete Denture - Maxillary$701
D5120Complete Denture - Mandibular$701
D5130Immediate Denture - Maxillary$729
D5140Immediate Denture - Mandibular$729
D5211Maxillary Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$687
D5212Mandibular Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$687
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$795
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$795
D5410Adjust Complete Denture - Maxillary$40
D5411Adjust Complete Denture - Mandibular$40
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$60
D5611Repair Resin Partial Denture Base, Mandibular20% Discount
D5630Repair or Replace Broken Retentive/Clasping Materials - Per Tooth$72
D5650Add Tooth to Existing Partial Denture$62
D5660Add Clasp to Existing Partial Denture - Per Tooth$80
D5730Reline Complete Maxillary Denture (chairside)$148
D5731Reline Complete Mandibular Denture (chairside) $148
D5740Reline Maxillary Partial Denture (chairside)$142
D5741Reline Mandibular Partial Denture (chairside)$142
D5750Reline Complete Maxillary Denture (laboratory)$194
D5751Reline Complete Mandibular Denture (laboratory)$194
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$484
D6241Pontic - Porcelain Fused to Predominantly Base Metal$446
D6242Pontic - Porcelain Fused to Noble Metal$465
D6750Retainer Crown - Porcelain Fused to High Noble Metal$533
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$481
D6752Retainer Crown - Porcelain Fused to Noble Metal$499
 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$153
D7220Removal of Impacted Tooth - Soft Tissue$122
D7230Removal of Impacted Tooth - Partially Bony$160
D7240Removal of Impacted Tooth - Completely Bony$231
D7250Removal of Residual Tooth Roots (cutting procedure)$122
D7310Alveoloplasty in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$102
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$147
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$75
 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$40
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$14
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$28
D9951Occlusal Adjustment - Limited$56
D9952Occlusal Adjustment - Complete$221

Exclusions and Limitations

  1. 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.
  2. 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.
  3. Fees subject to change.
  4. 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. Please call 800-290-0523 if you have any further questions.
  5. 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.
  6. 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.
  7. 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$17
D0140Limited Oral Evaluation - Problem Focused$24
D0150Comprehensive Oral Evaluation - New or Established Patient$28
D0210Intraoral - Complete Series of Radiographic Images$55
D0220Intraoral - Periapical First Radiographic Image$13
D0230Intraoral - Periapical Each Additional Radiographic Image$10
D0270Bitewing - Single Radiographic Image$13
D0272Bitewings - Two Radiographic Images$16
D0273Bitewings - Three Radiographic Images$23
D0274Bitewings - Four Radiographic Images$27
D0330Panoramic Radiographic Image$55
 Preventive ServicesMember Pays
D1110Prophylaxis - Adult$40
D1120Prophylaxis - Child$28
D1351Sealant - Per Tooth$27
D1510Space Maintainer - Fixed, Unilateral$116
D1516Space Maintainer - Fixed - Bilateral, Maxillary20% Discount
D1520Space Maintainer - Removable - Unilateral$149
D1526Space Maintainer - Removable - Bilateral, Maxillary20% Discount
Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$55
D2150Amalgam - Two Surfaces, Primary or Permanent$68
D2160Amalgam - Three Surfaces, Primary or Permanent$82
D2161Amalgam - Four or More Surfaces, Primary or Permanent$98
D2330Resin - Based Composite - One Surface, Anterior$65
D2331Resin - Based Composite - Two Surfaces, Anterior$82
D2332Resin - Based Composite - Three Surfaces, Anterior$104
D2335Resin - Based Composite - Four Or More Surfaces or Involving Incisal Angle (anterior)$128
D2391Resin - Based Composite - One Surface, Posterior$88
D2392Resin - Based Composite - Two Surfaces, Posterior$130
D2393Resin - Based Composite - Three Surfaces, Posterior$160
D2394Resin - Based Composite - Four or More Surfaces, Posterior$182
D2710Crown - Resin-Based Composite (indirect)$251
D2720Crown- Resin with High Noble Metal$532
D2750Crown - Porcelain Fused to High Noble Metal$630
D2751Crown - Porcelain Fused to Predominantly Base Metal$571
D2752Crown - Porcelain Fused to Noble Metal$594
D2790Crown - Full Cast High Noble Metal$620
D2791Crown - Full Cast Predominantly Base Metal$578
D2930Prefabricated Stainless Steel Crown - Primary Tooth$123
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$142
D2950Core Buildup, Including Any Pins When Required$123
D2951Pin Retention - Per Tooth, in Addition to Restoration$29
D2952Post and Core in Addition to Crown, Indirectly Fabricated$194
D2954Prefabricated Post and Core in Addition to Crown$152
 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$65
D3310Endodontic Therapy, Anterior Tooth (excluding final restoration)$363
D3320Endodontic Therapy, Premolar Tooth (excluding final restorations)$429
D3330Endodontic Therapy, Molar Tooth (excluding final restorations)$541
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$368
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$122
D4910Periodontal Maintenance$75
 Prosthodontics (Removeable) ServicesMember Pays
D5110Complete Denture - Maxillary$791
D5120Complete Denture - Mandibular$791
D5130Immediate Denture - Maxillary$825
D5140Immediate Denture - Mandibular$825
D5211Maxillary Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$722
D5212Mandibular Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$722
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$897
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$897
D5410Adjust Complete Denture - Maxillary$41
D5411Adjust Complete Denture - Mandibular$41
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$65
D5611Repair Resin Partial Denture Base, Mandibular20% Discount
D5630Repair or Replace Broken Retentive/Clasping Materials - Per Tooth$82
D5650Add Tooth to Existing Partial Denture$71
D5660Add Clasp to Existing Partial Denture - Per Tooth$90
D5730Reline Complete Maxillary Denture (chairside)$167
D5731Reline Complete Mandibular Denture (chairside)$167
D5740Reline Maxillary Partial Denture (chairside)$160
D5741Reline Mandibular Partial Denture (chairside)$160
D5750Reline Complete Maxillary Denture (laboratory)$219
D5751Reline Complete Mandibular Denture (laboratory)$219
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$543
D6241Pontic - Porcelain Fused to Predominantly Base Metal$504
D6242Pontic - Porcelain Fused to Noble Metal$526
D6750Retainer Crown - Porcelain Fused to High Noble Metal$603
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$543
D6752Retainer Crown - Porcelain Fused to Noble Metal$562
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$65
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$165
D7220Removal of Impacted Tooth - Soft Tissue$137
D7230Removal of Impacted Tooth - Partially Bony$180
D7240Removal of Impacted Tooth - Completely Bony$252
D7250Removal of Residual Tooth Roots (cutting procedure)$138
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$116
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$166
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$85
 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$44
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$16
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$29
D9951Occlusal Adjustment - Limited$62
D9952Occlusal Adjustment - Complete$249

Exclusions and Limitations

  1. 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.
  2. 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.
  3. Fees subject to change.
  4. 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. Please call 800-290-0523 if you have any further questions.
  5. 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.
  6. 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.
  7. 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$19
D0140Limited Oral Evaluation - Problem Focused$21
D0150Comprehensive Oral Evaluation - New or Established Patient$24
D0210Intraoral - Complete Series of Radiographic Images$57
D0220Intraoral - Periapical First Radiographic Image$13
D0230Intraoral - Periapical Each Additional Radiographic Image$9
D0270Bitewing - Single Radiographic Image$13
D0272Bitewings - Two Radiographic Images$17
D0273Bitewings - Three Radiographic Images$24
D0274Bitewings - Four Radiographic Images$28
D0330Panoramic Radiographic Image$57
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult $41
D1120Prophylaxis - Child $34
D1351Sealant - Per Tooth$28
D1510Space Maintainer - Fixed - Unilateral$122
D1516Space Maintainer - Fixed - Bilateral, Maxillary20% Discount
D1520Space Maintainer - Removable - Unilateral$160
D1526Space Maintainer - Removable - Bilateral, Maxillary20% Discount
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$57
D2150Amalgam - Two Surfaces, Primary or Permanent$72
D2160Amalgam - Three Surfaces, Primary or Permanent$85
D2161Amalgam - Four or More Surfaces, Primary or Permanent$104
D2330Resin - Based Composite - One Surface, Anterior$72
D2331Resin - Based Composite - Two Surfaces, Anterior$86
D2332Resin - Based Composite - Three Surfaces, Anterior$109
D2335Resin - Based Composite - Four or More Surfaces or Involving Incisal Angle (anterior)$137
D2391Resin - Based Composite - One Surface, Posterior$90
D2392Resin - Based Composite - Two Surfaces, Posterior$130
D2393Resin - Based Composite - Three Surfaces, Posterior$164
D2394Resin - Based Composite - Four or More Surfaces, Posterior$189
D2710Crown - Resin-Based Composite (indirect)$268
D2720Crown- Resin with High Noble Metal$569
D2750Crown - Porcelain Fused to High Noble Metal$674
D2751Crown - Porcelain Fused to Predominantly Base Metal$613
D2752Crown - Porcelain Fused to Noble Metal$657
D2790Crown - Full Cast High Noble Metal$659
D2791Crown - Full Cast Predominantly Base Metal$613
D2930Prefabricated Stainless Steel Crown - Primary Tooth$132
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$149
D2950Core Buildup - Including Any Pins When Required$132
D2951Pin Retention - Per Tooth in Addition to Restoration$32
D2952Post and Core in Addition to Crown, Indirectly Fabricated$207
D2954Prefabricated Post and Core in Addition to Crown$161
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$29
D3120Pulp Cap - Indirect (excluding final restoration)$29
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$72
D3310Endodontic Therapy - Anterior Tooth (excluding final restoration)$384
D3320Endodontic Therapy - Premolar Tooth (excluding final restorations)$457
D3330Endodontic Thearpy - Molar Tooth (excluding final restorations)$573
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$383
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$136
D4910Periodontal Maintenance$82
 Prosthodontics (Removable) ServicesMember Pays
D5110Complete Denture - Maxillary$826
D5120Complete Denture - Mandibular$826
D5130Immediate Denture - Maxillary$858
D5140Immediate Denture - Mandibular$858
D5211Maxillary Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$807
D5212Mandibular Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$807
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$937
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$937
D5410Adjust Complete Denture - Maxillary$47
D5411Adjust Complete Denture - Mandibular$47
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$72
D5611Repair Resin Partial Denture Base, Mandibular20% Discount
D5630Repair or Replace Broken Retentive/Clasping Materials - Per Tooth$86
D5650Add Tooth to Existing Partial Denture$75
D5660Add Clasp to Existing Partial Denture - Per Tooth$95
D5730Reline Complete Maxillary Denture (chairside)$179
D5731Reline Complete Mandibular Denture (chairside)$179
D5740Reline Maxillary Partial Denture (chairside)$168
D5741Reline Mandibular Partial Dent (chairside)$168
D5750Reline Complete Maxillary Denture (laboratory)$232
D5751Reline Complete Mandibular Denture (laboratory)$232
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$578
D6241Pontic - Porcelain Fused to Predominantly Base Metal$534
D6242Pontic - Porcelain Fused to Noble Metal$558
D6750Retainer Crown - Porcelain Fused to High Noble Metal$632
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$576
D6752Retainer Crown - Porcelain Fused to Noble Metal$600
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$72
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$174
D7220Removal of Impacted Tooth - Soft Tissue$147
D7230Removal of Impacted Tooth - Partially Bony$191
D7240Removal of Impacted Tooth - Completely Bony$268
D7250Removal of Residual Tooth Roots (cutting procedure)$138
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$122
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$178
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$90
 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$47
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$17
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$32
D9951Occlusal Adjustment - Limited$64
D9952Occlusal Adjustment - Complete$264

Exclusions and Limitations

  1. 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.
  2. 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.
  3. Fees subject to change.
  4. 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. Please call 800-290-0523 if you have any further questions.
  5. 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.
  6. 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.
  7. 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$20
D0140Limited Oral Evaluation - Problem Focused$25
D0150Comprehensive Oral Evaluation - New or Established Patient$25
D0210Intraoral - Complete Series of Radiographic Images$62
D0220Intraoral - Periapical First Radiographic Image$14
D0230Intraoral - Periapical Each Additional Radiographic Image$9
D0270Bitewing - Single Radiographic Image$14
D0272Bitewings - Two Radiographic Images$19
D0273Bitewings - Three Radiographic Images$25
D0274Bitewings - Four Radiographic Images$32
D0330Panoramic Radiographic Image$62
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult $45
D1120Prophylaxis - Child $39
D1351Sealant - Per Tooth$29
D1510Space Maintainer - Fixed, Unilateral$134
D1516Space Maintainer - Fixed - Bilateral, Maxillary20% Discount
D1520Space Maintainer - Removable - Unilateral$178
D1526Space Maintainer - Removable - Bilateral, Maxillary20% Discount
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$62
D2150Amalgam - Two Surfaces, Primary or Permanent$80
D2160Amalgam - Three Surfaces, Primary or Permanent$94
D2161Amalgam - Four or More Surfaces, Primary or Permanent$116
D2330Resin - Based Composite - One Surface, Anterior$80
D2331Resin - Based Composite - Two Surfaces, Anterior$95
D2332Resin - Based Composite - Three Surfaces or$121
D2335Resin - Based Composite - Four Or More Surfaces or Involving Incisal Angle (anterior)$152
D2391Resin - Based Composite - One Surface, Posterior$101
D2392Resin - Based Composite - Two Surfaces, Posterior$146
D2393Resin - Based Composite - Three Surfaces, Posterior$187
D2394Resin - Based Composite - Four or More Surfaces, Posterior$216
D2710Crown - Resin-Based Composite (indirect)$282
D2720Crown- Resin with High Noble Metal$598
D2750Crown - Porcelain Fused to High Noble Metal$701
D2751Crown - Porcelain Fused to Predominantly Base Metal$638
D2752Crown - Porcelain Fused to Noble Metal$680
D2790Crown - Full Cast High Noble Metal$687
D2791Crown - Full Cast Predominantly Base Metal$646
D2930Prefabricated Stainless Steel Crown - Primary Tooth$146
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$166
D2950Core Buildup - Including Any Pins When Required$146
D2951Pin Retention - Per Tooth, in Addition to Restoration$33
D2952Post and Core in Addition to Crown, Indirectly Fabricated$229
D2954Prefabricated Post and Core in Addition to Crown$179
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$33
D3120Pulp Cap - Indirect (excluding final restoration)$33
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$80
D3310Endodontic Therapy - Anterior Tooth (excluding final restoration)$399
D3320Endodontic Therapy - Premolar Tooth (excluding final restorations)$480
D3330Endodontic Thearpy - Molar Tooth (excluding final restorations)$607
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$422
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$138
D4910Periodontal Maintenance$88
 Prosthodontics (Removable) ServicesMember Pays
D5110Complete Denture - Maxillary$884
D5120Complete Denture - Mandibular$884
D5130Immediate Denture - Maxillary$952
D5140Immediate Denture - Mandibular$952
D5211Maxillary Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$865
D5212Mandibular Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$865
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$1,007
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$1,007
D5410Adjust Complete Denture - Maxillary$48
D5411Adjust Complete Denture - Mandibular$48
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$80
D5611Repair Resin Partial Denture Base, Mandibular20% Discount
D5630Repair or Replace Broken Retentive/Clasping Materials - Per Tooth$95
D5650Add Tooth to Existing Partial Denture$83
D5660Add Clasp to Existing Partial Denture - Per Tooth$106
D5730Reline Complete Maxillary Denture (chairside)$196
D5731Reline Complete Mandibular Denture (chairside)$196
D5740Reline Maxillary Partial Denture (chairside)$187
D5741Reline Mandibular Partial Dent (chairside)$187
D5750Reline Complete Maxillary Denture (laboratory)$258
D5751Reline Complete Mandibular Denture (laboratory)$258
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$633
D6241Pontic - Porcelain Fused to Predominantly Base Metal$584
D6242Pontic - Porcelain Fused to Noble Metal$607
D6750Retainer Crown - Porcelain Fused to High Noble Metal$661
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$613
D6752Retainer Crown - Porcelain Fused to Noble Metal$637
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$80
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$185
D7220Removal of Impacted Tooth - Soft Tissue$164
D7230Removal of Impacted Tooth - Partially Bony$211
D7240Removal of Impacted Tooth - Completely Bony$276
D7250Removal of Residual Tooth Roots (cutting procedure)$147
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$134
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$195
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$101
 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$50
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$19
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$34
D9951Occlusal Adjustment - Limited$74
D9952Occlusal Adjustment - Complete$293

Exclusions and Limitations

  1. 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.
  2. 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.
  3. Fees subject to change.
  4. 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. Please call 800-290-0523 if you have any further questions.
  5. 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.
  6. 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.
  7. 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$21
D0140Limited Oral Evaluation - Problem Focused$27
D0150Comprehensive Oral Evaluation - New or Established Patient$27
D0210Intraoral - Complete Series of Radiographic Images$64
D0220Intraoral - Periapical First Radiographic Image$15
D0230Intraoral - Periapical Each Additional Radiographic Image$9
D0270Bitewing - Single Radiographic Image$16
D0272Bitewings - Two Radiographic Images$20
D0273Bitewings - Three Radiographic Images$26
D0274Bitewings - Four Radiographic Images$33
D0330Panoramic Radiographic Image$64
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult $48
D1120Prophylaxis - Child $40
D1351Sealant - Per Tooth$32
D1510Space Maintainer - Fixed, Unilateral$143
D1516Space Maintainer - Fixed - Bilateral, Maxillary20% Discount
D1520Space Maintainer - Removable - Unilateral$171
D1526Space Maintainer - Removable - Bilateral, Maxillary20% Discount
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$64
D2150Amalgam - Two Surfaces, Primary or Permanent$83
D2160Amalgam - Three Surfaces, Primary or Permanent$98
D2161Amalgam - Four or More Surfaces, Primary or Permanent$121
D2330Resin - Based Composite - One Surface, Anterior$83
D2331Resin - Based Composite - Two Surfaces, Anterior$101
D2332Resin - Based Composite - Three Surfaces, Anterior$126
D2335Resin - Based Composite - Four or More Surfaces or Involving Incisal Angle (anterior)$160
D2391Resin - Based Composite - One Surface, Posterior$109
D2392Resin - Based Composite - Two Surfaces, Posterior$157
D2393Resin - Based Composite - Three Surfaces, Posterior$208
D2394Resin - Based Composite - Four or More Surfaces, Posterior$240
D2710Crown - Resin-Based Composite (indirect)$305
D2720Crown- Resin with High Noble Metal$645
D2750Crown - Porcelain Fused to High Noble Metal$749
D2751Crown - Porcelain Fused to Predominantly Base Metal$675
D2752Crown - Porcelain Fused to Noble Metal$713
D2790Crown - Full Cast High Noble Metal$722
D2791Crown - Full Cast Predominantly Base Metal$687
D2930Prefabricated Stainless Steel Crown - Primary Tooth$153
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$175
D2950Core Buildup, Including Any Pins When Required$153
D2951Pin Retention - Per Tooth, in Addition to Restoration$35
D2952Post and Core in Addition to Crown, Indirectly Fabricated$241
D2954Prefabricated Post and Core in Addition to Crown$187
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$34
D3120Pulp Cap - Indirect (excluding final restoration)$34
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$83
D3310Endodontic Therapy, Anterior Tooth (excluding final restoration)$450
D3320Endodontic Therapy, Premolar Tooth (excluding final restorations)$532
D3330Endodontic Therapy, Molar Tooth (excluding final restorations)$667
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$450
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$149
D4910Periodontal Maintenance$95
 Prosthodontics (Removable) ServicesMember Pays
D5110Complete Denture - Maxillary$972
D5120Complete Denture - Mandibular$972
D5130Immediate Denture - Maxillary$1,033
D5140Immediate Denture - Mandibular$1,033
D5211Maxillary Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$954
D5212Mandibular Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$954
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$1,086
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$1,086
D5410Adjust Complete Denture - Maxillary$50
D5411Adjust Complete Denture - Mandibular$50
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$83
D5611Repair Resin Partial Denture Base, Mandibular20% Discount
D5630Repair or Replace Broken Retentive/Clasping Materials - Per Tooth$101
D5650Add Tooth to Existing Partial Denture$87
D5660Add Clasp to Existing Partial Denture - Per Tooth$111
D5730Reline Complete Maxillary Denture (chairside)$208
D5731Reline Complete Mandibular Denture (chairside)$208
D5740Reline Maxillary Partial Denture (chairside)$196
D5741Reline Mandibular Partial Denture (chairside)$196
D5750Reline Complete Maxillary Denture (laboratory)$271
D5751Reline Complete Mandibular Denture (laboratory)$271
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$734
D6241Pontic - Porcelain Fused to Predominantly Base Metal$615
D6242Pontic - Porcelain Fused to Noble Metal$665
D6750Retainer Crown - Porcelain Fused to High Noble Metal$701
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$651
D6752Retainer Crown - Porcelain Fused to Noble Metal$666
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$83
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$191
D7220Removal of Impacted Tooth - Soft Tissue$170
D7230Removal of Impacted Tooth - Partially Bony$223
D7240Removal of Impacted Tooth - Completely Bony$298
D7250Removal of Residual Tooth Roots (cutting procedure)$157
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$143
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$207
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$105
 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$56
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$20
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$34
D9951Occlusal Adjustment - Limited$76
D9952Occlusal Adjustment - Complete$308

Exclusions and Limitations

  1. 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.
  2. 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.
  3. Fees subject to change.
  4. 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. Please call 800-290-0523 if you have any further questions.
  5. 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.
  6. 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.
  7. 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$25
D0140Limited Oral Evaluation - Problem Focused$29
D0150Comprehensive Oral Evaluation - New or Established Patient$36
D0210Intraoral - Complete Series of Radiographic Images$75
D0220Intraoral - Periapical First Radiographic Image$17
D0230Intraoral - Periapical Each Additional Radiographic Image$11
D0270Bitewing - Single Radiographic Image$17
D0272Bitewings - Two Radiographic Images$21
D0273Bitewings - Three Radiographic Images$27
D0274Bitewings - Four Radiographic Images$33
D0330Panoramic Radiographic Image$75
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult $56
D1120Prophylaxis - Child $45
D1351Sealant - Per Tooth$39
D1510Space Maintainer - Fixed, Unilateral$164
D1516Space Maintainer - Fixed - Bilateral, Maxillary20% Discount
D1520Space Maintainer - Removable - Unilateral$211
D1526Space Maintainer - Removable - Bilateral, Maxillary20% Discount
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$75
D2150Amalgam - Two Surfaces, Primary or Permanent$95
D2160Amalgam - Three Surfaces, Primary or Permanent$112
D2161Amalgam - Four or More Surfaces, Primary or Permanent$137
D2330Resin - Based Composite - One Surface, Anterior$95
D2331Resin - Based Composite - Two Surfaces, Anterior$117
D2332Resin - Based Composite - Three Surfaces, Anterior$146
D2335Resin - Based Composite - Four or More Surfaces or Involving Incisal Angle (anterior)$183
D2391Resin - Based Composite - One Surface, Posterior$122
D2392Resin - Based Composite - Two Surfaces, Posterior$179
D2393Resin - Based Composite - Three Surfaces, Posterior$226
D2394Resin - Based Composite - Four or More Surfaces, Posterior$258
D2710Crown - Resin-Based Composite (indirect)$335
D2720Crown- Resin with High Noble Metal$710
D2750Crown - Porcelain Fused to High Noble Metal$836
D2751Crown - Porcelain Fused to Predominantly Base Metal$815
D2752Crown - Porcelain Fused to Noble Metal$827
D2790Crown - Full Cast High Noble Metal$855
D2791Crown - Full Cast Predominantly Base Metal$810
D2930Prefabricated Stainless Steel Crown - Primary Tooth$167
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$187
D2950Core Buildup - Including Any Pins When Required$164
D2951Pin Retention - Per Tooth, in Addition to Restoration$41
D2952Post and Core in Addition to Crown, Indirectly Fabricated$270
D2954Prefabricated Post and Core in Addition to Crown$205
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$41
D3120Pulp Cap - Indirect (excluding final restoration)$39
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$95
D3310Endodontic Therapy - Anterior Tooth (excluding final restoration)$513
D3320Endodontic Therapy - Premolar Tooth (excluding final restorations)$607
D3330Endodontic Thearpy - Molar Tooth (excluding final restorations)$763
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$529
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$172
D4910Periodontal Maintenance$107
 Prosthodontics (Removable) ServicesMember Pays
D5110Complete Denture - Maxillary$1,107
D5120Complete Denture - Mandibular$1,107
D5130Immediate Denture - Maxillary$1,166
D5140Immediate Denture - Mandibular$1,166
D5211Maxillary Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$1,089
D5212Mandibular Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$1,089
D5213Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$1,245
D5214Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases (including any conventional clasps, rests and teeth)$1,245
D5410Adjust Complete Denture - Maxillary$59
D5411Adjust Complete Denture - Mandibular$59
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$95
D5611Repair Resin Partial Denture Base, Mandibular20% Discount
D5630Repair or Replace Broken Retentive/Clasping Materials - Per Tooth$117
D5650Add Tooth to Existing Partial Denture$101
D5660Add Clasp to Existing Partial Denture - Per Tooth$128
D5730Reline Complete Maxillary Denture (chairside)$231
D5731Reline Complete Mandibular Denture (chairside)$231
D5740Reline Maxillary Partial Denture (chairside)$217
D5741Reline Mandibular Partial Dent (chairside)$217
D5750Reline Complete Maxillary Denture (laboratory)$299
D5751Reline Complete Mandibular Denture (laboratory)$299
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$766
D6241Pontic - Porcelain Fused to Predominantly Base Metal$707
D6242Pontic - Porcelain Fused to Noble Metal$729
D6750Retainer Crown - Porcelain Fused to High Noble Metal$815
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$768
D6752Retainer Crown - Porcelain Fused to Noble Metal$798
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$95
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$199
D7220Removal of Impacted Tooth - Soft Tissue$195
D7230Removal of Impacted Tooth - Partially Bony$254
D7240Removal of Impacted Tooth - Completely Bony$334
D7250Removal of Residual Tooth Roots (cutting procedure)$183
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$164
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$235
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$121
 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$62
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$25
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$41
D9951Occlusal Adjustment - Limited$87
D9952Occlusal Adjustment - Complete$353

Exclusions and Limitations

  1. 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.
  2. 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.
  3. Fees subject to change.
  4. 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. Please call 800-290-0523 if you have any further questions.
  5. 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.
  6. 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.
  7. 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$26
D0140Limited Oral Evaluation - Problem Focused$39
D0150Comprehensive Oral Evaluation - New or Established Patient$44
D0210Intraoral - Complete Series of Radiographic Images$75
D0220Intraoral - Periapical First Radiographic Image$15
D0230Intraoral - Periapical Each Additional Radiographic Image$13
D0270Bitewing - Single Radiographic Image$14
D0272Bitewings - Two Radiographic Images$20
D0273Bitewings - Three Radiographic Images$25
D0274Bitewings - Four Radiographic Images$29
D0330Panoramic Radiographic Image$63
 Preventative ServicesMember Pays
D1110Prophylaxis - Adult $49
D1120Prophylaxis - Child $39
D1351Sealant - Per Tooth$29
D1510Space Maintainer - Fixed, Unilateral$187
D1516Space Maintainer - Fixed - Bilateral, Maxillary20% Discount
D1520Space Maintainer - Removable - Unilateral$223
D1526Space Maintainer - Removable - Bilateral, Maxillary20% Discount
 Restorative ServicesMember Pays
D2140Amalgam - One Surface, Primary or Permanent$62
D2150Amalgam - Two Surfaces, Primary or Permanent$83
D2160Amalgam - Three Surfaces, Primary or Permanent$100
D2161Amalgam - Four or More Surfaces, Primary or Permanent$122
D2330Resin - Based Composite - One Surface, Anterior$77
D2331Resin - Based Composite - Two Surfaces, Anterior$98
D2332Resin - Based Composite - Three Surfaces, Anterior$126
D2335Resin - Based Composite - Four or More Surfaces or Involving Incisal Angle (anterior)$157
D2391Resin - Based Composite - One Surface, Posterior$87
D2392Resin - Based Composite - Two Surfaces, Posterior$122
D2393Resin - Based Composite - Three Surfaces, Posterior$157
D2394Resin - Based Composite - Four or More Surfaces, Posterior$185
D2710Crown - Resin-Based Composite (indirect)$267
D2720Crown- Resin with High Noble Metal$568
D2750Crown - Porcelain Fused to High Noble Metal$667
D2751Crown - Porcelain Fused to Predominantly Base Metal$600
D2752Crown - Porcelain Fused to Noble Metal$625
D2790Crown - Full Cast High Noble Metal$646
D2791Crown - Full Cast Predominantly Base Metal$564
D2930Prefabricated Stainless Steel Crown - Primary Tooth$150
D2931Prefabricated Stainless Steel Crown - Permanent Tooth$174
D2950Core Buildup - Including Any Pins When Required$152
D2951Pin Retention - Per Tooth, in Addition to Restoration$33
D2952Post and Core in Addition to Crown, Indirectly Fabricated$238
D2954Prefabricated Post and Core in Addition to Crown$187
 Endodontic ServicesMember Pays
D3110Pulp Cap - Direct (excluding final restoration)$40
D3120Pulp Cap - Indirect (excluding final restoration)$40
D3220Therapeutic Pulpotomy (excluding final restoration) - Removal of Pulp Coronal to the Dentinocemental Junction and Application of Medicament$95
D3310Endodontic Therapy, Anterior Tooth (excluding final restoration)$380
D3320Endodontic Therapy, Premolar Tooth (excluding final restoration)$457
D3330Endodontic Therapy - Molar Tooth (excluding final restoration)$576
 Periodontic ServicesMember Pays
D4210Gingivectomy or Gingivoplasty - Four or More Contiguous Teeth or Tooth Bonded Spaces Per Quadrant$360
D4341Periodontal Scaling and Root Planing - Four or More Teeth Per Quadrant$133
D4910Periodontal Maintenance$77
 Prosthodontics (Removable) ServicesMember Pays
D5110Complete Denture - Maxillary$859
D5120Complete Denture - Mandibular$859
D5130Immediate Denture - Maxillary$906
D5140Immediate Denture - Mandibular$911
D5211Maxillary Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$645
D5212Mandibular Partial Denture - Resin Base (including retentive/clasping materials, rests, and teeth)$645
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)$929
D5410Adjust Complete Denture - Maxillary$46
D5411Adjust Complete Denture - Mandibular$46
D5520Replace Missing or Broken Teeth - Complete Denture (each tooth)$94
D5611Repair Resin Partial Denture Base, Mandibular20% Discount
D5630Repair or Replace Broken Retentive/Clasping Materials - Per Tooth$133
D5650Add Tooth to Existing Partial Denture$116
D5660Add Clasp to Existing Partial Denture - Per Tooth$141
D5730Reline Complete Maxillary Denture (chairside)$195
D5731Reline Complete Mandibular Denture (chairside)$195
D5740Reline Maxillary Partial Denture (chairside)$182
D5741Reline Mandibular Partial Denture (chairside)$182
D5750Reline Complete Maxillary Denture (laboratory)$263
D5751Reline Complete Mandibular Denture (laboratory)$259
 Implant ServicesMember Pays
D6000 through D609620% Discount
 Prosthodontics (Fixed) ServicesMember Pays
D6240Pontic - Porcelain Fused to High Noble Metal$645
D6241Pontic - Porcelain Fused to Predominantly Base Metal$602
D6242Pontic - Porcelain Fused to Noble Metal$619
D6750Retainer Crown - Porcelain Fused to High Noble Metal$666
D6751Retainer Crown - Porcelain Fused to Predominantly Base Metal$602
D6752Retainer Crown - Porcelain Fused to Noble Metal$622
 Oral Surgery ServicesMember Pays
D7140Extraction, Erupted Tooth or Exposed Root (elevation and/or forcepts removal)$80
D7210Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth, and Including Elevation of Mucoperiosteal Flap if Indicated$199
D7220Removal of Impacted Tooth - Soft Tissue$178
D7230Removal of Impacted Tooth - Partially Bony$225
D7240Removal of Impacted Tooth - Completely Bony$277
D7250Removal of Residual Tooth Roots (cutting procedure)$164
D7310Alveoloplasty in Conjunction with Extraction - Four or More Teeth or Tooth Spaces, Per Quadrant$161
D7320Alveoloplasty not in Conjunction with Extractions - Four or More Teeth or Tooth Spaces, Per Quadrant$226
D7510Incision and Drainage of Abscess - Intraoral Soft Tissue$106
 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$58
D9215Local Anesthesia in Conjunction With Operative or Surgical Procedures$25
D9230Inhalation of Nitrous Oxide/Anxiolysis, Analgesia$34
D9951Occlusal Adjustment - Limited$88
D9952Occlusal Adjustment - Complete$360

Exclusions and Limitations

  1. 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.
  2. 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.
  3. Fees subject to change.
  4. 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. Please call 800-290-0523 if you have any further questions.
  5. 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.
  6. 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.
  7. 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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