Contact Us   |   Sign In   |   Register
How You Save with Affordable Dental!

Affordable Dental Reduced Fee Schedule:


This list of approved procedures will help you know before your appointment the costs of your treatment.  All professional Dentists in the offices accepting the Affordable Dental membership program have agreed to charge Affordable Dental members the following published fees.

Download PDF      


DIAGNOSTIC (Exams, X-rays)

ADA Code

Procedure

Typical Fee

You Pay

Savings

D0120 periodic oral evaluation - established patient $46 NC 100%
D0140 limited oral evaluation - problem focused $69 NC 100%
D0150 comprehensive oral evaluation - new or established patient $80 NC 100%
D0210 intraoral - complete series (including bitewings) $118 $46   61%
D0220 intraoral - periapical first film $26 NC 100%
D0230 intraoral - periapical each additional film $22 NC 100%
D0270 bitewing - single film $26 NC 100%
D0272 bitewing - two films $41 NC 100%
D0273 bitewing - three films $51 NC 100%
D0274 bitewing - four films $59 NC 100%
D0330 panoramic film $99 $46   54%
PREVENTIVE (Cleanings, etc.)
ADA Code Procedure Typical Fee You Pay Savings
D1110 prophylaxis - adult $82 NC 100%
D1120 prophylaxis - child $60 NC 100%
D1351 sealant - per tooth $50 $21 58%
D1510 space maintainer - fixed - unilateral $285 $148 48%
D1515 space maintainer - fixed - bilateral $384 $222 42%
D1520 space maintainer - removable - unilateral $349 $174 50%
D1525 space maintainer - removable - bilateral $438 $240 45%
RESTORATIVE (Fillings)
ADA Code Procedure Typical Fee You Pay Savings
D2140 amalgam - one surface, primary or permanent $127 $58 54%
D2150 amalgam - two surfaces, primary or permanent $161 $73 55%
D2160 amalgam - three surfaces, primary or permanent $199 $88 56%
D2161 amalgam - four or more surfaces, primary or permanent $233 $104 55%
D2330 resin-based composite - one surface, anterior $147 $78 47%
D2331 resin-based composite - two surfaces, anterior $182 $104 43%
D2332 resin-based composite - three surfaces, anterior $227 $112 51%
D2335 resin-based composite - four or more surfaces or involving incisal angle (anterior) $282 $119 58%
D2391 resin-based composite - one surface, posterior $163 $86 47%
D2392 resin-based composite - two surfaces, posterior $211 $110 48%
D2393 resin-based composite - three surfaces, posterior $262 $136 48%
D2394 resin-based composite - four or more surfaces, posterior $311 $139 55%
RESTORATIVE (Crowns)
ADA Code Procedure Typical Fee You Pay Savings
D2710 crown - resin-based composite (indirect) $869 $230 73%
D2750 crown - porcelain fused to high noble metal $1,006 $635 37%
D2751 crown - porcelain fused to predominantly base metal $927 $495 47%
D2752 crown - porcelain fused to noble metal $948 $600 37%
D2790 crown - full cast high noble metal $1,011 $625 38%
D2791 crown - full cast predominantly base metal $894 $469 48%
D2930 prefabricated stainless steel crown - primary tooth $240 $128 47%
D2931 prefabricated stainless steel crown - permanent tooth $293 $144 51%
D2950 core buildup, including any pins $240 $104 57%
D2951 pin retention - per tooth, in addition to restoration $67 $26 61%
D2952 post and core in addition to crown, indirectly fabricated $376 $193 49%
D2954 prefabricated post and core in addition to crown $300 $144 52%
ENDODONTICS (Root Canals, etc.)
ADA Code Procedure Typical Fee You Pay Savings
D3110 pulp cap - direct (excluding final restoration) $75 $31 59%
D3120 pulp cap - indirect (excluding final restoration) $76 $31 59%
D3220 therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament $178 $80 55%
D3310 endodontic therapy, anterior tooth (excluding final restoration) $652 $392 40%
D3320 endodontic therapy, bicuspid tooth (excluding final restoration) $752 $480 36%
D3330 endodontic therapy, molar (excluding final restoration) $912 $600 34%
PERIODONTICS (Scaling/Deep Cleaning/Root Planing, etc.)
ADA Code Procedure Typical Fee You Pay Savings
D4210 gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant $569 $287 50%
D4341 periodontal scaling and root planing - four or more teeth per quadrant $232 $122 47%
D4910 periodontal maintenance $125 $69 45%
PROSTHODONTICS (Dentures - Removable, Partials, etc.)
ADA Code Procedure Typical Fee You Pay Savings
D5110 complete denture - maxillary $1,537 $806 48%
D5120 complete denture - mandibular $1,537 $806 48%
D5130 immediate denture - maxillary $1,642 $849 48%
D5140 immediate denture - mandibular $1,643 $849 48%
D5211 maxillary partial denture - resin based (including any conventional clasps, rests and teeth) $1,219 $568 53%
D5212 mandibular partial denture - resin based (including any conventional clasps, rests and teeth) $1,221 $568 53%
D5213 maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) $1,599 $884 45%
D5214 mandibular partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) $1,600 $884 45%
D5410 adjust complete denture - maxillary $80 $38 53%
D5411 adjust complete denture - mandibular $80 $38 53%
D5510 repair broken complete denture base $190 $119 37%
D5520 replace missing or broken teeth - complete denture (each tooth) $169 $110 35%
D5630 repair or replace broken clasp $236 $164 31%
D5650 add tooth to existing partial denture $200 $78 61%
D5660 add clasp to existing partial denture $244 $127 48%
D5730 reline complete maxillary denture (chair side) $336 $135 60%
D5731 reline complete mandibular denture (chair side) $333 $135 59%
D5740 reline maxillary partial denture (chair side) $329 $110 67%
D5741 reline mandibular partial denture (chair side) $333 $110 67%
D5750 reline complete maxillary denture (laboratory) $429 $239 44%
D5751 reline complete mandibular denture (laboratory) $429 $239 44%
PROSTHODONTICS - FIXED (Bridges, Dentures, etc.)
ADA Code Procedure Typical Fee You Pay Savings
D6065 implant support porcelain/ceramic crown $1,400 $960 31%
D6066 implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) $1,402 $960 32%
D6067 implant supported metal crown (titanium, titanium alloy, high noble metal) $1,421 $760 46%
D6240 pontic - porcelain fused to high noble metal $1,002 $600 40%
D6241 pontic - porcelain fused to predominantly base metal $927 $540 42%
D6242 pontic - porcelain fused to noble metal $951 $600 37%
D6750 crown - porcelain fused to high noble metal $1,007 $608 40%
D6751 crown - porcelain fused to predominantly base metal $912 $540 41%
D6752 crown - porcelain fused to noble metal $942 $600 36%
ORAL SURGERY (Tooth Extractions, etc.)
ADA Code Procedure Typical Fee You Pay Savings
D7140 extraction, erupted tooth or exposed root (elevation and/or forceps removal) $156 $67 57%
D7210 surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated $248 $165 33%
D7220 removal of impacted tooth - soft tissue $281 $195 31%
D7230 removal of impacted tooth - partially bony $356 $230 35%
D7240 removal of impacted tooth - completely bony $434 $270 38%
D7250 surgical removal of residual tooth roots (cutting procedure) $281 $130 54%
D7310 alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant $274 $112 59%
D7320 alveoloplasty not in conjunction with extractions - four or more teeth or tooth spaces, per quadrant $400 $149 63%
D7510 incision and drainage of abscess - intraoral soft tissue $211 $78 63%
D9110 palliative (emergency) treatment of dental pain - minor procedure $117 $48 59%
D9215 local anesthesia in conjunction with operative or surgical procedures $59 $29 51%
D9230 inhalation of nitrous oxide / analgesia, anxiolysis $72 $30 58%


DISCLAIMERS

General Information
This schedule applies to services provided by an Affordable Dental Professional Dentist accepting the Affordable Dental membership program. The purpose of this schedule is to establish the maximum fee that a General Dentist will charge for each procedure. The member is responsible for all charges at the time of service. Fee schedules are subject to change without prior notification to Members. Members must remain in the membership a minimum of 12 months subject to their right to cancel within 30 days from the effective date of the membership. Membership payments are made to Affordable Dental, Inc. Membership also provides a Reduced Fee Schedule for other dental services as well. You pay ONLY the Reduced Fee Schedule amount for any comprehensive procedures directly to your selected Dental Office. All procedures may not be covered by your membership – consult the Reduced Fee Schedule before your appointment with the General Dentist accepting Affordable Dental. Procedures not listed on this schedule will be discounted up to 20% off of the General Dentist’s normal fee. If the General Dentist’s normal fee for any procedure is less than the fee listed on this schedule, the dentist will charge up to 20% off of their normal fee for that procedure.


Dental Professionals accepting Affordable Dental
While all Dental Professionals accepting the Affordable Dental membership program are professionally licensed in the state in which they practice, Affordable Dental does not guarantee the quality of service of the providers. Any quality of care concerns involving any Professional Dentist accepting Affordable Dental should be directed in writing to: Affordable Dental, Inc., Attn: Patient Relations, P.O. Box 10084, Fort Smith, Arkansas 72917. Please call 479-434-5929 if you have any further questions.

Exceptions & Limitations
Excluded are Services for injuries or conditions that are covered under worker’s compensation or employer’s liability laws, services provided without cost to any subscribers by any municipality, county or political subdivision. Services which, in the opinion of the attending dentist, are not necessary for the patient’s health or that cannot be performed because of the general health condition of the patient are excluded. Periodontal therapy products and all fluoride products are excluded from the plan. Prescriptions that may be required before or after treatment, hospitalization, general anesthesia, and IV sedation are also excluded. Cost of dental care, which is covered under automobile medical, no fault, or similar type of insurance is excluded. This membership program is renewable at the option of Affordable Dental, Inc.

THIS IS NOT AN INSURANCE POLICY. THE DISCOUNTS IN THIS MEMBERSHIPS ARE NOT INSURANCE.
This is a discounted membership program that Dental Offices have agreed to accept and are willing to discount their usual fee schedule complying with the discounts previously named in this reduced fee schedule. The Dentist who started a procedure must complete the procedure and all coordination of related treatment and payments. Payment of specific procedures is non-transferable among affiliated offices; however, patients can be referred to other Dental Offices accepting Affordable Dental for different procedures.

Copyright© 2014 Affordable Dental, Inc.; Terms & Conditions

Sign up today and your membership is effective immediately

CONTACT US

Affordable Dental Inc.
P.O. Box 10084 | Fort Smith, AR 72917

Information:855-EZ-Afford | Patient Relations: 479-434-5929

All Rights Reserved 

get social

Membership Software Powered by YourMembership  ::  Legal